腹腔镜下全膀胱切除、去结肠带乙状结肠原位新膀胱术30例临床分析

摘要

目的：探讨腹腔镜下全膀胱切除、去结肠带乙状结肠原位新膀胱术的可行性，总结临床经验。方法：回顾性分析30例腹腔镜下全膀胱切除、去结肠带乙状结肠原位新膀胱术患者的临床资料，观察手术方法及预后效果。结果：腹腔镜下全膀胱切除术的手术时间为245~365 min，术中出血量为325~550 ml；去带乙状结肠原位新膀胱术的手术时间为175~312 min，术中出血量为225~450 ml。术后新膀胱呈U形状态，容量为200~360 ml，最大尿流为11~20 ml/s，膀胱残余量为0~20 ml。30例患者术后1个月均可达到自控排尿，术后6个月29例可完全自控排尿，1例患者出现夜间尿失禁，1例患者出现肠道综合征，1例出现切口感染。结论：腹腔镜下全膀胱切除、去结肠带乙状结肠原位新膀胱术具有创伤小、出血量少、恢复快等优点。%Objective:To discuss the feasibility of constructing detenial sigmoid neobladder after laparoscopic radical cystectomy and summarize clinical experience.Method:The clinical information about the 30 cases of constructing detenial sigmoid neobladder after laparoscopic radical cystectomy were reviewed and analyzed.The surgical methods and prognosis results were observed.Result:The cystectomy operation time was 245-365 min,and the bleeding during the operation was 325-550 ml.The orthotopic sigmoid colonic neobladder operation time was 175-312 min,and the bleeding during the operation was 225-450 ml.After the surgery,the new bladder took the U shape,with the capacity of 200-360 ml,maximum flow of 11-20 ml/s,and residual bladder volume of 0-20 ml.The 30 cases could control their own urinations one month after the operations.Six months after the surgeries,29 cases could control their own urinations,and one case suffered nighttime incontinence,one case showed signs of gut syndrome,and one case received wound infection.Conclusion:The constructing detenial sigmoid neobladder after laparoscopic radical cystectomy causes fewer traumas,less amount of bleeding and can achieve fast recovery.