腹腔镜辅助回肠新膀胱腹壁瘘修补术

摘要

Objective To explore an effective treatment of neobladder abdomino-cutaneous fis-tula after ileum orthotopic urinary diversion in radical cystectomy patients. Methods From 2013 to 2016,three patients with orthotopic neobladder abdominal cutaneous wall fistula were surgically repaired with laparoscopic assisted combined with open surgery.The key steps of surgery were to re-lease the intestine and fistula which was adhered to abdominal wall and the entire fistula was resected through laparoscopy.Then,through open procedure neobladder and abdominal wall were sutured and the anterior wall of the neo bladder was covered with greater omentum. Results All patients were successfully operated in single sitting without any complication.The patients were followed up for 1 2 to 26 months.No urine leakage was seen on cystography. Conclusions Laparoscopic assisted com-bined with open procedure to repair neobladder abdominal cutaneous fistula is an effective and reliable method to resolve this complication with high success rate and curative effect.%目的 探索根治性膀胱切除+回肠原位尿流改道术后新膀胱腹壁瘘的有效治疗方法. 方法 2013年至2016年,我院采用腹腔镜辅助下开放手术的方法,对3例回肠新膀胱腹壁瘘患者进行修补治疗.手术要点为首先在腹腔镜下松解与腹壁和瘘管周围形成粘连的肠管,腹腔镜引导下通过开放手术彻底切除整个瘘管,错位缝合新膀胱和腹壁,新膀胱前壁用大网膜覆盖. 结果 3例患者均一次手术获得成功,无手术并发症发生,随访12~26个月,新膀胱造影显示新膀胱无漏尿. 结论 腹腔镜辅助的开放新膀胱腹壁瘘修补术是解决新膀胱腹壁瘘的有效方法,手术成功率高,远期疗效可靠.