经腹膜外改良逆行膀胱全切术治疗男性肌层浸润性膀胱癌18例

发布时间：2018-06-17 11:52

本文选题：膀胱癌 + 肌层浸润性膀胱癌　；参考：《山东医药》2017年15期

【摘要】：目的观察经腹膜外途径行改良逆行膀胱全切术治疗男性肌层浸润性膀胱癌的效果。方法对18例男性T2期肌层浸润性膀胱癌患者施行经腹膜外改良逆行膀胱全切术。膀胱全切术后,4例行双侧输尿管皮肤造口术、1例行原位回肠新膀胱术、13例行回肠膀胱术。记录手术时间、术中出血量、术中输血情况和腹腔脏器暴露时间。记录术后盆腹腔引流管留置时间、通气时间和住院时间。术后随访并发症及局部复发和远处转移情况。结果本组18例手术均获得成功,手术时间145~310 min,术中出血量110~860 m L,术中输血3例,术中腹腔脏器暴露时间0~65 min;盆腹腔引流时间5~14 d,术后通气时间1~5 d,术后住院时间8~17 d。所有切除肿瘤组织切缘检查均为阴性,2例术后盆腔淋巴结报告阳性,给予GC方案化疗。术后无出血、周围组织及脏器损伤和切口感染等并发症发生。随访3~28个月,患者肾功能正常,未见局部复发及远处转移,随访期间无粘连性肠梗阻发生。结论经腹膜外途径行改良逆行膀胱全切术治疗男性肌层浸润性膀胱癌术中出血较少,腹腔干扰少,损伤较小,患者术后恢复快,住院时间缩短,粘连性肠梗阻发生率较低,疗效较好。
[Abstract]:Objective to observe the effect of modified retrograde cystectomy via extraperitoneal approach in the treatment of male myometrial invasive bladder cancer. Methods retrograde cystectomy was performed on 18 male patients with T 2 stage myometrial invasive bladder cancer. After total cystectomy, bilateral ureterostomy was performed in 4 cases and in situ ileal neobladder was performed in 13 cases. The operative time, intraoperative blood loss, intraoperative blood transfusion and exposure time of abdominal organs were recorded. The time of indwelling, the time of ventilation and the time of hospitalization were recorded. Postoperative complications, local recurrence and distant metastasis. Results all the 18 cases were successfully operated, the operative time was 145 min, the intraoperative bleeding volume was 110 ~ 860 mL, the intraoperative blood transfusion was 3 cases, the intraoperative exposure time of abdominal organs was 0 ~ 65 min, the time of pelvic drainage was 514 days, the postoperative ventilation time was 1 ~ 5 days, the postoperative hospitalization time was 817 days. All the resected tumor tissues were negative for pelvic lymph nodes and received GC regimen chemotherapy. There were no postoperative complications such as hemorrhage, injury of surrounding tissues and organs and infection of incision. All patients were followed up for 3 ~ 28 months. The renal function was normal, no local recurrence or distant metastasis was found, and no adhesive intestinal obstruction occurred during the follow-up. Conclusion modified retrograde total cystectomy via extraperitoneal approach for the treatment of male myometrial invasive bladder cancer has less bleeding, less intraperitoneal interference, less injury, faster postoperative recovery, shorter hospital stay, and lower incidence of adhesive intestinal obstruction. The curative effect is better.
【作者单位】：安徽省肿瘤医院;安徽省立医院;
【分类号】：R737.14

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