Extraperitoneal radical cystectomy with extraperitonealization of the ileal neobladder: a comparison to the transperitoneal technique
Extraperitoneal radical cystectomy with extraperitonealization of the ileal neobladder: a comparison to the transperitoneal technique
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DOI：
10.1007/s00345-009-0476-z
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发表时间：
2010-08-01
影响因子：
3.4
通讯作者：
Schrader, Mark
中科院分区：
文献类型：
--
作者：
Jentzmik, Florian;Schostak, Martin;Schrader, Mark
经腹膜根治性膀胱切除术联合腹膜内回肠新膀胱是肌侵性膀胱癌的标准手术治疗方法。为了降低发病率，我们在2002年建立了一种腹腔外入路，包括腹腔外切除回肠新膀胱。本回顾性研究比较了两种手术的结果，重点是围手术期和术后病程。本文分析了1998年1月至2007年5月在我院行根治性膀胱切除术并回肠新生膀胱的95例男性侵袭性尿路上皮癌患者。47例患者行经腹膜根治性膀胱切除术并腹腔内回肠新膀胱。其余48例接受腹腔外技术，新膀胱腹腔外化。我们比较了两种方法的手术时间、术中出血量、并发症和肿瘤预后。腹腔外入路术后肠梗阻发生率明显低于经腹腔入路（2/48 vs 10/47; p = 0.012）。然而盆腔淋巴囊肿更常见（6例vs. 0例；p = 0.014）。两种技术在其他主要和次要并发症、手术时间（平均377.4分钟vs. 405.4分钟）或术中出血量（平均363毫升vs. 412毫升）方面没有差异。肿瘤结果显示两种技术之间没有差异。腹腔外技术与回肠新膀胱腹腔外化在安全性和可靠性方面与经腹膜手术方法相当，并且根据我们所检查的参数产生良好的围手术期和术后结果。值得注意的是术后肠梗阻发生率显著降低，淋巴囊肿发生率较高。两者都可能是由单独的腹膜外区域愈合过程引起的。
Transperitoneal radical cystectomy with intraperitoneal ileal neobladder is the standard surgical treatment for muscle-invasive bladder cancer. To reduce morbidity, we established in 2002 an extraperitoneal approach including extraperitonealization of the ileal neobladder. This retrospective study compares the results of the two procedures with a focus on the peri- and postoperative course.Ninety-five male patients with invasive urothelial cancer who underwent radical cystectomy with ileal neobladder at our hospital from January 1998 to May 2007 were analyzed. Forty-seven patients underwent transperitoneal radical cystectomy with intraperitoneal ileal neobladder. The remaining 48 were submitted to the extraperitoneal technique with extraperitonealization of the neobladder. We compared both methods regarding operating time, intraoperative blood loss, complications and oncological outcome.The incidence of postoperative ileus was significantly lower after the extraperitoneal than after the transperitoneal approach (2/48 vs. 10/47 cases; p = 0.012). However, pelvic lymphoceles were more frequent (6 vs. 0 cases; p = 0.014). The two techniques did not differ with regard to the other major and minor complications, the operating time (mean 377.4 vs. 405.4 min) or the intraoperative blood loss (mean 363 vs. 412 ml). Oncological outcome disclosed no difference between both techniques.The extraperitoneal technique with extraperitonealization of the ileal neobladder is comparable in safety and reliability to the transperitoneal surgical approach and yields good peri- and postoperative results with regard to the parameters we examined. Noteworthy are the significant reduction of postoperative ileus and the higher incidence of lymphoceles. Both may be caused by the separate extraperitoneal regional healing processes.