2004 3 25 3 Chin J Urol March 2004 Vol 25 No. 3 175 (15 ) 15 3971 59 14 1 5 2 2 ; ; ; 45 cm 50 cm M 1 cm 6 4 11 510 h 6. 5 h ; 2001000 ml 387 ml 3 KUB IVU : 300 ml 46 ; ; ; ; Laparoscopic radical cystectomy with orthotopic ileal neobladder( report of 15 cases) HUANG Jian YAO You2sheng XU Ke2wei et al. Department of Urology Second Affiliated Hospital of Sun Yat2sen University Guangzhou 510120 China Abstract Objective To present the initial experience and results of the laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder. Methods Fifteen patients (14 men and 1 women) with invasive blad2 der carcinoma underwent LRC with orthotopic ileal neobladder. The mean age was 59. 5 years(range 39 to 71 years). The LRC with orthotopic ileal neobladder consists of 3 major steps namely laparoscopic cystectomy extra2 corporeal formation of ileal pouch and laparoscopic urethra2pouch anastomosis. With 5 trocars the surgeon conduct2 ed the procedure through the 2 ports on the left side and the assistants did so on the right side and hold the laparo2 scope. The bilateral pelvic lymphadenectomy were performed first. The ureters were dissected just outside the blad2 der. The radical cystoprostatectomy was performed for the male patients. The total bladder uterus and appendage were removed for the female patient. A 4 to 5 cm median incision in lower abdomen was made to remove the surgi2 cal specimens and construct the ileal pouch. A 50 cm ileal loop was taken from the abdominal cavity isolated de2 tubularized and reconfigured intomshaped pouch with running suture. The anti2refluxing ureter implantation was performed by inserting the 1 cm of ureter into the pouch and suturing them. For the first 4 cases the urethra2 neobaldder anastomosis was completed through the abdominal incision ;while for the other 11 cases the anastomosis was done under the laparoscope. Results The mean duration of surgery was 5 to 10 h with a mean of 6. 5 h ;the : (962205201) :510120

176 2004 3 25 3 Chin J Urol March 2004 Vol 25 No. 3 blood loss was 200 to 1000 ml with a mean of 387 ml. During a follow2up of 1 to 11 months all patients were alive and asymptomatic with normal upper tracts and had no evidence of local recurrence or metastasis. 4 to 6 weeks after surgery all the patients with orthotopic ileal bladder had complete daytime continence and nocturnal continence was achieved with 2 to 3 times voiding at night. Conclusions This procedure combines the advantages of minimally invasive laparoscopy with the speediness of open surgery. The laparoscopic cystoprostactomy has a magnified clear vision which makes meticulous manipulation possible and reduces bleeding sphincter injury and nerve bundle in2 jury. Shorter time of intestine exposure during the procedure is good for recovery of intestinal function and for reduc2 ing postoperative intestinal adhesion. External construction of ileal pouch shortens operation time remarkably. Ileal segment has long and mobile mesentery thereby can be easily taken out through a small abdomen incision and anastomosed with urethra stump without tension so it is more suitable for construction of a pouch. Key words Bladder neoplasms ; Peritoneoscopy ; Radical cystectomy ; Ileal neobladder 3. : 2002 12 2003 11 15 4. : 15 3971 59 14 1 14 1 TNM : T 2 N 0 M 0 8 T 3a N 0 M 0 4 T 3b N 0 M 0 1 T 3b N 1 M 0 2 WHO : G 1 1 G 2 9 G 3 5 15 1. : 10 cm 15 (1) : 12 mm 30 4 1. ;2. 45 cm 1 12 cm 12 mm 23 cm 5 mm 2. : 23 mm

2004 3 25 3 Chin J Urol March 2004 Vol 25 No. 3 177 5. : 220 Dexon 6 1 2 3 6. : 220 Dexon 1 7. : Liga2 Dexon sure Ligasure 510 h 6. 5 h 1 8. : 10 h 2 9 8 h 12 56. 5 h 6 h 2001000 ml 387 ml 2 800 1000 ml 13 200350 ml 268 ml 15 23 d 12 d 20 F Foley 9. : 45 cm 46 8 F 3 KUB IVU 15 cm 50 cm : M 320 Dexon 300 ml (2) (1) 10. : 1 cm 420 Dexon 56 0. 8 cm (1) 11. 2 : 4 220 Dexon 2 4 6 8 10 12 3 3 10 ml 11 :Foley 2 15 2 4 IVU

178 2004 3 25 3 Chin J Urol March 2004 Vol 25 No. 3 [1 ] 56 h : 4 ; 11 ( 1) 34 h 1 h : [2 3 ] Turk [4 ] 5 Gill [5 ] 2 ; 8. 5 10. 5 h Endo2GIA 45 3 cm Foley Gaboardi [6 ] 5 cm ; ; ; 1. (68

中国科技论文在线 2004 3 25 3 Chin J Urol March 2004 Vol 25 No. 3 179 ). 2002 23 :4612463. 2 Maxwell2Armstrong CA Robinson MH Scholefield JH. Laparoscopic col2 orectal cancer surgery. Am J Surg 2000 179 :5002507. 3 Targarona EM Balague C Knook MM et al. Laparoscopic surgery and surgical infection. Br J Surg 2000 87 :5362544. 4 Turk I Deger S Winkelmann B et al. Laparoscopic radical cystectomy with continent urinary diversion (rectal sigmoid pouch) performed com2 pletely intracorporeally : the initial 5 cases. J Urol 2001 165 (6 Pt 1) : 186321866. 5 Gill IS Kaouk JH Meraney AM et al. Laparoscopic radical cystectomy and continent orthotopic ileal neobladder performed completely intracorpo2 really :the initial experience.j Urol 2002 168 :13218. 6 Gaboardi F Simonato A Galli S et al. Minimally invasive laparoscopic neobladder.j Uorl 2002 168 :108021083. ( :2003212231) ( : ) (MFH) : 1997 4 9 CT 2001 5 3 2 56 1999 11 CT2040 HU 1 23 1997 4 1 : 1 : : 6 T 37. 9 B 4 cm 3 cm 3 cm 10 cm 8 cm 6 cm : IVU CT 2 : WBC 6. 8 G/ L ( ESR) 40 mm/ 1 h 55 mm/ 2 hb 11. 5 cm 8. 5 cm 6. 0 cm 3 2 IVU : 2 CT 2 12 cm 8 cm 6 cm CT 1154 HU 10 d : : 7 cm 5 cm 5 cm : 1 WBC 8. 9 10 9 / L ( Hb) 84 g/ 4 cm 3 cm 3 cm L ESR 30 mm/ 1 h 50 mm/ 2 hb 1 9 1 :110001 IVU MFH MFH 3 33 2001 5 2 2 8 cm 6 cm 5 cm 6 ( :2003206210) ( : )