摘要
目的探讨经脐单切口三角位腹腔镜手术(SITUS)在腹膜外入路膀胱部分切除术中的应用体会。方法2017年7月至2019年4月,对13例平均年龄(68.00±5.22)岁、肿瘤最大径平均(3.2±0.8)cm的T2~T3期膀胱癌患者行SITUS腹膜外入路膀胱部分切除术。改进的手术操作包括切口的开关技术、腹膜外入路膀胱部分切除及膀胱缝合方法。记录术中出血量、手术时间、术后住院时间、切缘和组织病理及术后并发症。术后定期随访行CT扫描及膀胱镜检查监测有无肿瘤复发及转移。结果13例手术均取得成功,无中转开放病例,1例增加1个辅助Trocar。平均手术时间(180.00±22.31)min,术中估计平均出血量(53.85±10.91)mL,术后平均住院时间(6.00±1.91)d,留置导尿管时间平均(7.60±0.96)d。围手术期无严重并发症发生。术后病理诊断尿路上皮癌9例,乳头状腺癌1例,脐尿管癌2例,副神经节瘤1例。所有病例切缘病例均为阴性。术后中位随访15个月,11例未发现肿瘤局部复发或远处转移,2例出现膀胱内局部肿瘤复发。结论SITUS腹膜外入路膀胱部分切除术安全可行,并且具有创伤小、恢复快、安全性高、美容效果好等优点,是不能耐受或拒绝行膀胱根治性切除术患者较为理想的手术方法。
Objective To summarize the preliminary experience of laparoscopic partial cystectomy with single incision triangulated umbilical surgery(SITUS)through extraperitoneal approach.Methods From July 2017 to April 2019,13 cases of bladder cancer patients with stage T2 or T3 disease underwent extraperitoneal laparoscopic partial cystectomy with SITUS.The mean age was(68.00±5.22)years.The mean size of tumors was(3.2±0.8)cm in the maximum diameter.The modified procedures of surgery consisted of the incision open and close,extraperitoneal laparoscopic partial cystectomy and suture technique.The estimated blood loss,operating time,mean hospital stay,postoperative complications,surgical margins and the mass pathology were recorded.Follow-up was done by performing CT scan and cystoscopy regularly to monitor tumor recurrence and metastasis regularly.Results All procedures of laparoscopic partial cystectomy were completed successfully without conversion to open surgery and only one case used aided trocar.The mean operating time was(180.00±22.31)min,and estimated blood loss was(53.85±10.91)mL.The mean postoperative hospitalization was(6.00±1.91)days.The mean duration of catheter was(7.60±0.96)days.No serious postoperative complications were occurred.The pathology included urothelium carcinoma in9 cases,papillary carcinoma in 1 case,urachal carcinoma in2 cases and paraganglioma in1 case.The surgical margins were negative in all cases.At the median follow-up of 15 months,no recrudescence or metastasis was detected in 11 patients,but 2 patients presented regional recurrence.Conclusion Extraperitoneal partial cystectomy with SITUS is feasible and safe for some patients who cannot undergo or refuse radical cystectomy,with the advantage of minimally invasive,fast recovery and good cosmetic effect,although it is more difficult than traditional laparoscopic procedure.And the effectiveness of this technique will be further evaluated.
作者
窦小亮
汪涌
陈晓鹏
龙强
高小平
张波
祝广峰
DOU Xiao-liang;WANG Yong;CHEN Xiao-peng;LONG Qiang;GAO Xiao-ping;ZHANG Bo;ZHU Guang-feng(Department of Urology,Tangdu Hospital,Air Force Medical University,Xi an 710038,China)
出处
《现代泌尿外科杂志》
CAS
2020年第9期793-797,共5页
Journal of Modern Urology
基金
唐都医院院创新基金(No.2015新技术新业务)。
关键词
膀胱切部分除术
腹腔镜
经脐单切口三角位手术
膀胱癌
partial cystectomy
laparoscope
single-incision triangulated umbilical surgery
Bladder cancer
