摘要目的 探讨女性膀胱癌患者机器人辅助根治性膀胱切除(RARC)后全腹腔内手工重建原位回肠W形新膀胱的初步疗效.方法 回顾性分析2017年12月至2018年3月我院收治的5例女性膀胱癌患者的临床资料.年龄51～68岁,平均62.2岁;体重指数13.6 ～22.8 kg/m2,平均18.1kg/m2.美国麻醉医师协会(ASA)评分1～3分,平均2分.术前明确病理诊断为膀胱尿路上皮癌.均行RARC+双侧盆腔淋巴结清扫术+全腹腔内原位回肠W形新膀胱重建.切除标本从阴道取出,全腹腔内截取40cm回肠,去肠管化,纯手工构建W形新膀胱.嘱患者术后第2天下床活动,术后3d进食,术后12 d拔除双侧上尿路单J管,术后14 d拔除尿管.结果 5例手术均顺利完成.手术时间355 ～428 min,平均384.2 min;术中估计出血量150～1 800 ml,平均620 nd.淋巴结清扫数目为10～20个,平均15个.术后腹部除套管切口外无其他切口.1例患者拔除尿管后出现新膀胱尿道吻合口瘘,予留置尿管2周后瘘口愈合.1例患者术后3周出现小肠梗阻,保守治疗后恢复.术后随访4～7个月,中位时间5.5个月.5例均日间尿控良好,1例夜间仍有尿失禁.术后复查未见肿瘤复发或转移,影像学检查示上尿路及新膀胱形态良好.结论 女性膀胱癌患者行RARC后全腹腔内手工重建原位回肠W形新膀胱,避免了腹部长切口,术后并发症少,尿控恢复满意,安全、可行,但肿瘤学指标仍需长期随访.

abstractsObjective To report the technique and effect of robotic-assisted laparoscopic radical cystectomy (RARC) totally intracorporeal orthotopic ileal neobladder in female bladder cancer patient.Methods A consecutive series of 5 female patients with urothelial carcinoma of the bladder,who underwent RARC,bilateral pelvic lymph node dissection and intracorporeal orthotopic W-shaped ileal neobladder by an experienced robotic surgeon,were included in the retrospective study,from December 2017 to March 2018.Data were reviewed retrospectively.The patients aged 51-68 years old,with mean age 62.2 years,and BMI was 13.6-22.8 kg/m2,mean 18.1 kg/m2.The specimens were removed from the vagina.A 40 cm bowel segment with detubularisation was chosen for the W-shaped neobladder which was constructed manually.All patients resumed ambulation on postoperative 2 days and resumed oral feeding on postoperative day 3.The single-J stents and catheter were removed 12 days and 2 weeks after operation,respectively.Results All operation were performed successfully.The average operation time was 384.2 min (ranging 355-428 min) with mean estimated blood loss of 620 ml (ranging 150-1 800 ml).And the average number of dissected lymph nodes was 15 (ranging 10-20).The neobladder and urethra anastomotic leakage was observed in one patient who was healed after 2 weeks indwell catheter.Small bowel obstruction occurred in one case 3 weeks after operation and recovered after conservative treatment.The daytime urinary control was good,and 1 cases had urinary incontinence at night (follow up 4-7months,median:5.5months).No recurrence or metastasis was observed during routine follow-up.The imaging showed the good morphology of the upper urinary tract and the new bladder.Conclusions Our initial experience supports the feasibility and advantage of totally intracorporeal orthotopic W-shaped ileal neobladder following RARC in female patient with bladder cancer.It is worth to further verification in a large sample with longer follow-up.