Extraperitoneal laparoscopic radical cystectomy and extraperitoneal ileal orthotopic neobladder: clinical experience of 112 patients
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摘要: 目的探讨腹膜外途径腹腔镜下根治性膀胱全切术(ELRC)和原位回肠膀胱术(EION)的手术方法，评价其临床效果。方法回顾性分析2018年3月—2022年3月在青岛大学附属医院行ELRC和EION的112例患者的临床资料，包括手术方式、手术时间、术中出血量、术后并发症等，对ELRC和EION的手术方法及治疗效果进行分析总结。结果112例患者均手术顺利，无术中转开放手术。手术时间为(229.08±37.97) min，术中出血量为(182.13±68.79) mL，住院时间为(13.22±4.75) d。术后病理回报13例为原位癌；Ta~T1 17例，T2 62例，T3 15例，T4 5例；3例患者同时存在前列腺癌。随访(16.17±9.14)个月，主要并发症为泌尿道感染与淋巴漏，术后肠梗阻发生率仅为2.68%。患者大部分可原位腹压排尿，并在术后6个月获得白天控尿。结论ELRC和EION具有对腹腔干扰小、术后肠道功能恢复快及术后并发症发生率低等优点。标准的操作流程可明显缩短手术时间、降低手术难度，是临床上医生可供选择的手术。Abstract: ObjectiveTo explore the methods of extraperitoneal laparoscopic radical cystectomy(ELRC) and extraperitoneal ileal orthotopic neobladder(EION), and evaluate their clinical outcomes.MethodsThe clinical data of 112 patients in the Affiliated Hospital of Qingdao University who underwent ELRC and EION from March 2018 to March 2022 were retrospectively analyzed and summarized, including the surgical method, operation time, intraoperative blood loss, and follow-up of postoperative complications.ResultsAll 112 patients underwent successful surgery without conversion to open. The operation time was (229.08±37.97)min, the intraoperative blood loss was (182.13±68.79)mL, and the hospital stay was (13.22±4.75)d. Postoperative pathological results showed that 13 cases were carcinoma in situ, 17 cases were Ta-T1, 62 cases were T2, 15 cases were T3, and 5 cases were T4. Three patients had prostate cancer simultaneously. The follow-up time was (16.17±9.14)months. The main complications were urinary tract infection and lymphorrhagia. The incidence of postoperative intestinal obstruction was 2.68%. Most patients were able to urinate with in situ abdominal pressure and achieved daytime continence 6 months after surgery.ConclusionThe main advantages of ELRC and EION were less interference to the abdominal cavity, quick recovery of postoperative intestinal function, and low incidence of postoperative complications. Procedural operation can significantly shorten the operation time and reduce the difficulty of operation, so it is an optional operation for surgeons.
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Key words:
- extraperitoneal /
- laparoscopy /
- bladder cancer /
- neobladder /
- complications
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表 1 患者一般资料
X±S 项目 数值 性别/例(%) 男 97(86.6) 女 15(13.4) 年龄/岁 63.76±6.20 BMI/(kg·m-2) 24.23±5.31 ASA评分 2.08±0.44 血红蛋白/(g·L-1) 133.45±8.57 白蛋白/(g·L-1) 34.32±6.13 高血压/例(%) 12(10.71) 糖尿病/例(%) 7(6.25) 心血管疾病/例(%) 9(8.04) ASA：美国麻醉师协会评分。 
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表 2 患者围手术期情况
X±S 项目 数值 手术时间/min 229.08±37.97 术中失血量/mL 182.13±68.79 术后第1天血红蛋白/(g·L-1) 109.54±13.90 术后第1天白蛋白/(g·L-1) 27.84±5.55 清扫淋巴结数目/个 16.40±4.28 淋巴结阳性数/例 7 切缘阳性/例 2 术中输血/例 1 经口进食时间/d 3.13±0.95 平均住院日/d 13.22±4.75 花费/元 64 385.46±10 075.97 随访时间/月 16.17±9.14 原位癌/例(%) 13(11.61) Ta~T1/例(%) 17(15.18) T2/例(%) 62(55.36) T3/例(%) 15(13.39) T4/例(%) 5(4.46) 前列腺癌/例(%) 3(2.68)
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表 3 患者术后并发症数据
例(%) 项目 数值 感染 29(25.89) 肠梗阻 3(2.68) 尿道狭窄 2(1.79) 输尿管口狭窄 4(3.57) 肠瘘 1(0.89) 淋巴漏 7(6.25) Clavien-Dindo分级 1 35(31.25) 2 3(2.68) 3 7(6.25) 4 1(0.89)
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