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目的探讨手助腹腔镜根治性膀胱切除术的临床应用价值。方法采用手助腹腔镜行根治性膀胱切除术31例,其中利用手助操作通道的切口行回肠膀胱术24例,原位回肠新膀胱术7例;并观察围手术期的恢复情况及近期疗效。结果31例手助腹腔镜下根治性膀胱切除均获成功,手术时间245～530 min,平均365.7 min;出血量100～500 ml,平均250.9 ml。其中3例需输血,输血率为9.7%。术后进食时间为2～15 d,平均4.3 d。住院时间平均19.7 d(9～83 d)。术后6例发生围手术期并发症,占19.4%。31例患者均获随访,平均18个月(1～38个月),2例回肠膀胱切口疝,1例输尿管新膀胱吻合口狭窄。肺部转移及局部复发并全身转移各1例,带瘤生存。肿瘤转移死亡1例,猝死1例。其余27例无瘤存活。结论手助腹腔镜根治性膀胱切除术是安全、可行的,尤其在复杂的根治性膀胱切除术中可以减少手术出血,降低手术难度,有效防止并发症的发生。
Objective To investigate the clinical value of hand-assisted laparoscopic radical cystectomy. Methods Thirty-one cases underwent laparoscopic radical cystectomy with hand-assisted laparoscopy. 24 cases were treated with hand-assisted approach and 7 cases were treated with ileal neo-bladder surgery. The perioperative recovery and immediate effect . Results 31 cases of hand-assisted laparoscopic radical cystectomy were successful, the operative time was 245-530 min (mean 365.7 min); the amount of bleeding was 100-500 ml (average 250.9 ml). Of these, 3 required blood transfusions, with a transfusion rate of 9.7%. Postoperative eating time for 2 ~ 15 d, an average of 4.3 d. The average duration of hospitalization was 19.7 days (9 to 83 days). Perioperative complications occurred in 6 patients (19.4%). All 31 patients were followed up for an average of 18 months (range 1 to 38 months), 2 cases of ileal incisional hernia and 1 case of ureteric anastomotic stenosis. Pulmonary metastasis and local recurrence and systemic metastasis in 1 case, with tumor survival. 1 patient died of tumor metastasis and 1 patient died of sudden death. The remaining 27 tumor-free survival. Conclusions Hand-assisted laparoscopic radical cystectomy is safe and feasible, especially in complicated radical cystectomy, which can reduce the bleeding of operation, reduce the difficulty of operation and prevent the complication effectively.