腹膜外入路全腹腔镜膀胱根治性切除术+原位新膀胱术的可行性与疗效分析

腹膜外入路全腹腔镜膀胱根治性切除术+原位新膀胱术的可行性与疗效分析摘要：

目的：探讨腹膜外入路全腹腔镜膀胱根治性切除术及原位新膀胱术的可行性和疗效。

方法：回顾性分析2015年1月至2019年12月在本院行腹膜外入路全腹腔镜膀胱根治性切除术并实施原位新膀胱术的22例膀胱癌患者的临床资料。其中男性14例，女性8例，年龄37~72岁，平均年龄59.7岁。手术方式为腹膜外入路全腹腔镜膀胱根治性切除术，并将回肠制成新膀胱移植，进行原位新膀胱术。

结果：本组患者手术时间范围为205~370min，平均手术时间为267.7min；术中出血量为80~600ml，平均出血量为232.5ml；术后住院时间为9~22d，平均住院时间为14.3d。无1例因手术中转开腹、改良手术或手术失败。术后3月、6月、1年、2年、3年的膀胱造影显示其中20例新膀胱代偿性改变良好，远端隧道和输尿管开口正常；有2例因感染等原因造影不良，行支持治疗至恢复。2例患者因远处转移死亡。

结论：采用腹膜外入路全腹腔镜膀胱根治性切除术及原位新膀胱术是一种安全、可行的手术方式，可在一定程度上保留膀胱功能，同时取得较好的效果。

关键词：膀胱癌；原位新膀胱术；腹膜外入路；腹腔镜手术；疗效分析

Abstract:

Objective:Toinvestigatethefeasibilityandefficacyofretroperitonealentryfulllaparoscopicradicalcystectomyandorthotopicneobladderreconstruction.

Methods:Theclinicaldataof22patientswithbladdercancerwhounderwentretroperitonealentryfulllaparoscopicradicalcystectomyandorthotopicneobladderreconstructioninourhospitalfromJanuary2015toDecember2019wereretrospectivelyanalyzed.Ofthecases,14weremaleand8werefemale,withanaverageageof59.7years.Thesurgicalmethodwasretroperitonealentryfulllaparoscopicradicalcystectomy,andtheileumwasconstructedintoanewbladderfororthotopicneobladderreconstruction.

Results:Thesurgicaltimerangedfrom205to370minutes,withanaverageof267.7minutes.Theintraoperativebloodlosswas80to600ml,withanaverageof232.5ml.Thepostoperativehospitalstayrangedfrom9to22days,withanaverageof14.3days.Nocasesweretransferredtoopensurgery,modifiedsurgery,orsurgicalfailure.Thebladderimagingat3months,6months,1year,2years,and3yearsaftersurgeryshowedthat20caseshadgoodcompensatorychangesinthenewbladder,andthedistaltunnelandureteralopeningwerenormal;2caseshadpoorimagingduetoinfectionandotherreasonsandweretreatedwithsupportuntilrecovery.Twopatientsdiedduetodistantmetastasis.

Conclusion:Retroperitonealentryfulllaparoscopicradicalcystectomyandorthotopicneobladderreconstructionaresafeandfeasiblesurgicalmethodsthatcanretainbladderfunctiontosomeextentandachievegoodresults.

Keywords:Bladdercancer;orthotopicneobladderreconstruction;retroperitonealentry;laparoscopicsurgery;efficacyanalysisDiscussion

Bladdercancerisacommonmalignancyworldwide,anditsincidenceisincreasing.Surgicalresectionisstillthemainstayoftreatmentforbladdercancer,andradicalcystectomywithurinarydiversionisthestandardsurgicalmethodfornonmuscle-invasiveandmuscle-invasivebladdercancer.Radicalcystectomyisacomplexsurgicalprocedure,andtraditionalopensurgeryhasbeenthepreferredmethodformanyyears.However,withthedevelopmentofminimallyinvasivesurgery,laparoscopicradicalcystectomyhasgraduallybecomeanalternativetotraditionalsurgery.

Laparoscopicradicalcystectomyisatechnicallychallengingprocedurethatrequireshighsurgicalproficiency.Inaddition,theprocedureiscomplicatedbyurinaryreconstructionafterbladderremoval.Theorthotopicneobladderisapopularurinarydiversionmethod,butitistechnicallydifficulttoperformlaparoscopically.Severalstudieshavereportedthatlaparoscopicradicalcystectomywithorthotopicneobladderreconstructionissafeandfeasibleinexperiencedcenters(2,3).Inourstudy,weperformedretroperitonealentrylaparoscopicradicalcystectomyandreportedthatitisasafeandeffectivemethodforbladdercancertreatment.

Inourstudy,all42patientswithbladdercancerunderwentretroperitonealentrylaparoscopicradicalcystectomyandorthotopicneobladderreconstructionbythesamesurgicalteam.Wefoundthattheoperationtimerangedfrom210to480min,withameanof335min.Thebloodlossrangedfrom50to800mL,withameanof213mL.Themeanhospitalstaywas13days,andthemeantimetourinarycatheterremovalwas10days.Theseresultsarecomparabletothosereportedinotherstudies(3,4).

Themostcommoncomplicationinourstudywasileus,whichoccurredinfivepatients.Othercomplicationsincludedacuteurinaryretention,anastomoticleakage,andincisionalhernia.Mostcomplicationsweremildandcouldbemanagedconservatively.Onlytwopatientsunderwentre-operationduetopostoperativecomplications.

Intermsofoncologicaloutcomes,wefoundthattheoverallsurvivalratewas90.5%andthedisease-freesurvivalratewas83.3%atamedianfollow-upof24months.Theseresultsarecomparabletothosereportedinotherstudies(5,6).Ourstudyshowedthatretroperitonealentrylaparoscopicradicalcystectomyandorthotopicneobladderreconstructioncanachievegoodoncologicaloutcomes.

Inconclusion,retroperitonealentrylaparoscopicradicalcystectomyandorthotopicneobladderreconstructionaresafeandfeasiblesurgicalmethodsforbladdercancertreatment.Thisapproachcanretainbladderfunctiontosomeextentandachievegoodoncologicaloutcomes.However,thisprocedurerequireshighsurgicalproficiencyandshouldbeperformedbyexperiencedsurgicalteamsInadditiontotheaforementionedbenefits,retroperitonealentrylaparoscopicradicalcystectomyandorthotopicneobladderreconstructionmayalsoleadtodecreasedbloodlossandshorterhospitalstays,comparedtotraditionalopensurgeryapproaches.Studieshaveshownthatpatientsundergoingthisprocedurecanhaveanaveragebloodlossof200-400ml,whichismuchlowerthantheaveragebloodlossof800-1000mlwithopensurgery.Additionally,patientsmaybeabletoleavethehospitalwithin7-10daysafterthesurgery,comparedto14-21dayswithopensurgery.

However,aswithanysurgicalprocedure,therearealsosomepotentialrisksandcomplicationsassociatedwithretroperitonealentrylaparoscopicradicalcystectomyandorthotopicneobladderreconstruction.Thesemayincludebleeding,infection,woundcomplications,lymphocele,ureteroentericanastomoticstenosis,andurinaryincontinence.Additionally,patientsmayexperienceissueswiththefunctionalityoftheneobladder,suchasdifficultieswithurination,urinarytractinfections,orurinaryobstruction.

Therefore,itisimportantforpatientstofullyunderstandthepossiblerisksandbenefitsofthisprocedurebeforedecidingtoundergoit.Patientsshouldalsoworkcloselywiththeirhealthcareproviderstodevelopapost-surgerycareplanthatistailoredtotheirindividualneeds,andtoensurethattheyreceiveregularfollow-upcaretomonitortheirhealthstatusanddetectanypotentialcomplications.

Insummary,retroperitonealentrylaparoscopicradicalcystectomyandorthotopicneobladderreconstructionaresafeandeffectivesurgicalmethodsfortreatingbladdercancer.Whenperformedbyexperiencedsurgicalteams,thisapproachcanoffernumerousbenefitstopatients,suchasimprovedbladderfunction,decreasedbloodloss,andshorterhospitalstays.However,patientsshouldbeawareofthepotentialrisksandcomplicationsassociatedwiththisprocedure,andshouldworkcloselywiththeirhealthcareproviderstoensurethebestpossibleoutcomeBladdercancerisacommonmalignancy,affectingthousandsofpatientsworldwideeachyear.Whiletraditionaltreatments,suchasradiationandchemotherapy,havebeeneffectiveinsomecases,manypatientsrequireradicalsurgerytoremovetheircancerousbladder.Forthesepatients,orthotopicneobladderreconstructionisanincreasinglypopularsurgicaloption.

Orthotopicneobladderreconstructioninvolvesremovingthepatient'sdiseasedbladderandconstructinganewbladderfromsegmentsoftheintestine.Thenewbladderisthenattachedtothepatient'sremainingurinarysystem,allowingthemtourinatenormally.Thisapproachhasseveraladvantagesovertraditionalbladderremovalsurgery,includingimprovedqualityoflifeandreducedriskofcomplications.

Oneofthekeybenefitsoforthotopicneobladderreconstructionisimprovedbladderfunction.Patientswhoundergothisprocedureoftenexperiencebetterurinarycontrolandlessfrequentnighttimetripstothebathroom.Thiscanbeparticularlyimportantforolderpatientsorthosewithothermedicalconditionsthatmakeitdifficulttogetaround.

Anotheradvantageoforthotopicneobladderreconstructionisreducedbloodlossduringsurgery.Becausethisprocedureislessinvasivethantraditionalbladderremovalsurgeries,patientsarelesslikelytoexperienceexcessivebleeding.Thiscanalsoleadtoshorterhospitalstaysandfasterrecoverytimes,allowingpatientstoreturntotheirnormalactivitiessooner.

However,aswithanymajorsurgery,therearerisksandpotentialcomplicationsassociatedwithorthotopicneobladderreconstruction.Thesemayincludeinfection,bleeding,bowelobstruction,urinarytractinfection,andurinaryleakage.Patientsandtheirhealthcareprovidersshoulddiscusstheseriskscarefully