[1]庹舟廷 张映 刘昆 汪鑫 王进有 毕良宽**.三孔法完全腹腔镜Studer原位新膀胱术30例临床分析[J].中国微创外科杂志,2022,01(5):375-380.
　Tuo Zhouting,Zhang Ying,Liu Kun,et al.Clinical Analysis of Threeport Laparoscopic Intracorporeal Studer Orthotopic Neobladder: Report of 30 Cases[J].Chinese Journal of Minimally Invasive Surgery,2022,01(5):375-380.
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三孔法完全腹腔镜Studer原位新膀胱术30例临床分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年5期
页码:
375-380
栏目:
临床研究
出版日期:
2022-07-21

文章信息/Info

Title:
Clinical Analysis of Threeport Laparoscopic Intracorporeal Studer Orthotopic Neobladder: Report of 30 Cases
作者:
庹舟廷 张映 刘昆 汪鑫 王进有 毕良宽**
(安徽医科大学第二附属医院泌尿外科，合肥230601)
Author(s):
Tuo Zhouting;  Zhang Ying;  Liu Kun;  et al.
Department of Urology, Second Hospital of Anhui Medical University, Hefei 230601, China
关键词:
完全腹腔镜手术; 膀胱根治性切除; Studer原位新膀胱术; 尿流改道
Keywords:
Intracorporeal laparoscopy; Radical cystectomy; Studer orthotopic neobladder; Urinary diversion
文献标志码:
A
摘要:
目的探讨三孔法完全腹腔镜Studer原位新膀胱术的安全性及疗效。方法2019年3月~2020年10月，对30例男性膀胱癌行三孔法腹腔镜膀胱根治性切除淋巴结清扫术，均保留血管神经束，关闭侧腹膜后，采用三孔法完全腹腔镜Studer原位新膀胱术完成尿流改道。结果手术顺利完成，手术时间（284.1±32.4）min，中位估计失血量100（55~300）ml，中位术后住院时间15（8~22）d。中位淋巴结清扫数目22（11~37）枚，淋巴结阳性1例。pT1N0期10例，pT2aN0期8例，pT2bN0期5例，pT3aN0期6例，pT3aN1期1例。住院期间并发症14例，ClavienDindo分级Ⅰ级10例，Ⅱ级4例。中位随访时间13（3~22)个月，无死亡。术后3个月评估，新膀胱容量（305±63）ml。28例日间自主排尿满意，17例夜间需要定时排尿1~2次。22例随访时间满1年，术后12个月中位国际勃起功能问卷5（IIEF5)评分14.5（7~23）分。1例因双肾严重积水行输尿管新膀胱再植，1例肿瘤局部复发。结论三孔法完全腹腔镜Studer原位新膀胱术治疗膀胱癌安全可靠，在肿瘤根治、新膀胱容量、男性尿控和性功能恢复等方面效果较满意。
Abstract:
ObjectiveTo explore the safety and efficacy of threeport laparoscopic intracorporeal Studer orthotopic neobladder (TLISON).MethodsFrom March 2019 to October 2020, thirty male patients with bladder cancer underwent threeport laparoscopic radical cystectomy and lymph node dissection. During the operation, the vascular nerve bundle was preserved, and after closing the lateral peritoneum, the urinary diversion was completed by TLISON.ResultsThe operation was successfully completed. The operation time was (284.1±32.4) min, the estimated median blood loss was 100 ml (range, 55-300 ml), and the median postoperative hospital stay was 15 d (range, 8-22 d). The median number of lymph nodes cleared was 22 (range, 11-37), with 1 case of positive lymph node. Postoperative pathology showed 10 cases of pT1N0, 8 cases of pT2aN0, 5 cases of pT2bN0, 6 cases of pT3aN0 and 1 case of pT3aN1. Inhospital complications occurred in 14 cases. The ClavienDindo classification showed 10 cases in Grade Ⅰ and 4 cases in Grade Ⅱ. The median followup time was 13 months (range, 3-22 months), and there was no death. The volume of the new bladder was (305±63) ml evaluated at 3 months postoperatively. There were 28 cases of satisfied with spontaneous urination in daytime, and 17 cases needing to urinate regularly once or twice at night. A total of 22 cases were followed up for one year, and the median International Index of Erectile Function Questionnaire 5 (IIEF5) score was 14.5 (range, 7-23) at 12 months after operation. One case underwent ureter neobladder replantation due to severe hydronephrosis, and one case had local tumor recurrence.ConclusionsTLISON operation is safe and reliable in the treatment of bladder cancer. It has satisfactory results in radical resection of tumor, new bladder volume, male urinary control and sexual function recovery.

参考文献/References:

[1]Witjes JA,Bruins HM,Cathomas R,et al.European Association of Urology guidelines on muscleinvasive and metastatic bladder cancer:summary of the 2020 guidelines.Eur Urol,2021,79(1):82-104.
[2]Chade DC,Laudone VP,Bochner BH,et al.Oncological outcomes after radical cystectomy for bladder cancer:open versus minimally invasive approaches.J Urol,2010,183(3):862-869.
[3]张多兵,彭龙飞,何可,等.三孔法腹腔镜膀胱根治性切除术的初步应用.中国微创外科杂志,2021,21(2):169-174.
[4]艾青,程强,赵旭鹏,等.单中心40例机器人全腔内Studer原位新膀胱术的疗效分析.中华泌尿外科杂志,2020,41(11):835-839.
[5]王帅,祁小龙,刘锋,等.完全腔镜下根治性膀胱切除术及体内原位新膀胱重建术：10年回顾性分析.中华泌尿外科杂志,2020,41(11):830-834.
[6]汤进,蒋先镇,汤育新.IIEF5与NEVA检测在阴茎勃起功能障碍诊断中的意义.中国男科学杂志,2006,20(1):41-43.
[7]毕良宽,丁德茂,王进有,等.外侧入路三层面法在腹腔镜盆腔淋巴清扫中的应用.中山大学学报(医学版),2018,39(3):463-466.
[8]Furrer MA,Studer UE,Gross T,et al.Nervesparing radical cystectomy has a beneficial impact on urinary continence after orthotopic bladder substitution,which becomes even more apparent over time.BJU Int,2018,121(6):935-944.
[9]黄健,韩金利.根治性膀胱切除及尿流改道术加速康复外科专家共识.中华泌尿外科杂志,2018,39(7):481-484.
[10]中华医学会泌尿外科学分会,中国膀胱癌联盟.根治性膀胱切除尿流改道术中国膀胱癌联盟共识.中华泌尿外科杂志,2021,42(7):481-484.
[11]Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg,2004,240(2):205-213.
[12]Matin SF,Gill IS.Laparoscopic radical cystectomy with urinary diversion:completely intracorporeal technique.J Endourol,2002,16(6):335-341.
[13]Haber GP,Campbell SC,Colombo JJ,et al.Perioperative outcomes with laparoscopic radical cystectomy:“pure laparoscopic” and “openassisted laparoscopic” approaches.Urology,2007,70(5):910-915.
[14]Hussein AA,Elsayed AS,Aldhaam NA,et al.A comparative propensity scorematched analysis of perioperative outcomes of intracorporeal vs extracorporeal urinary diversion after robotassisted radical cystectomy:results from the International Robotic Cystectomy Consortium.BJU Int,2020,126(2):265-272.
[15]Chan EP,Nair SM,Hetou K,et al.Longitudinal experience with Studer neobladders:Outcomes and complications.Can Urol Assoc J,2021,15(8):E386-E392.
[16]吴丽媛,杨飞亚,牟廉洁,等.完全腹腔镜根治性膀胱切除术+邢氏原位回肠新膀胱的可行性和疗效.中华泌尿外科杂志,2020，41(2):90-91.
[17]汪鑫,朱猛,任立新,等.完全腹腔镜根治性膀胱切除+ρ形原位回肠新膀胱术的应用研究.中华泌尿外科杂志,2019，40(10):747-748.
[18]刘锋,王帅,祁小龙,等.完全腹腔镜下根治性膀胱切除及原位U形回肠新膀胱术19例报告.中华泌尿外科杂志,2015,36(4):270-275.
[19]王文宽,王明帅,宋黎明,等.腹腔镜根治性膀胱切除术体内与体外原位回肠新膀胱术的临床疗效比较.中华泌尿外科杂志,2018,39(7):500-504.
[20]Anderson CB,Morgan TM,Kappa S,et al.Ureteroenteric anastomotic strictures after radical cystectomy：does operative approach matter?J Urol,2013,189(2):541-547.
[21]刘浩,何旺,范新祥,等.劈开乳头式与直接吻合式输尿管-肠道新膀胱吻合方法的前瞻性临床随机对照研究.中华泌尿外科杂志,2018,39(7):495-499.
[22]Canda AE,Atmaca AF,Altinova S,et al.Robotassisted nervesparing radical cystectomy with bilateral extended pelvic lymph node dissection (PLND) and intracorporeal urinary diversion for bladder cancer:initial experience in 27 cases.BJU Int,2012,110(3):434-444.
[23]Qin X,Zhang H,Wan F,et al.Retrograde radical cystectomy and consequent peritoneal cavity reconstruction benefits localized male bladder cancer:results from a cohort study.World J Surg Oncol,2015,13(1):132.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金面上项目(81572107)；安徽省自然科学基金面上项目(2108085MH297)；安徽医科大学校科研基金（2021xkj164）;安徽医科大学第二附属医院临床研究培育计划项目（2020LCZD03,2021LCZD04)**通讯作者，Email：biliangkuan@126.com
更新日期/Last Update: 2022-07-21