| Objective:Assessment the long-term clinical results of laparoscopic radical resection of bladder cancer + orthotopic ileal neobladder for bladder cancer.Methods:Collected a total of 87 males and 7 females from March 2008 to October 2014,who had have laparoscopic radical resection of bladder cancer + orthotopic ileal neobladder at the First Affiliated Hospital of Nanchang University. Collected data of cases demographics, preoperative complications, pathological staging, postoperative chemotherapy, more than 3 months postoperative survival and recurrence in patients with follow-up status, the results were statistically analyzed.Result:In this study, all of the 94 patients underwent laparoscopic radical resection of bladder cancer + orthotopic ileal neobladder. 83 cases of which had standard pelvic lymphadenectomy, the average number of removed lymph nodes was 14.23 ± 7.86.Other 11 cases had extensive pelvic lymphadenectomy, the average number of removed lymph nodes was 19.4±10.26. The pathological staging after surgical: 24(25.5%) cases had Lymph node metastasis, 40( 42.5%) cases’ tumers were non-organ confined. The median follow-up time is 26 monthes(3 ~ 54 monthes).There were 4 cases had lost, 37 cases(39.3%)had finished more than 30 monthes follow-up, 67 cases(71.3%) had no postoperative metastasis and recurrence, 23cases(24.5%)had tumer progression(1 case had neobladder recurrence, 9 cases had local recurrence, 13 case had distant metastasis). 27 patients had died(17 out of which died of tumor progression, 10 out of which died of other reasons). The rates of overall survival(OS) and relapse-free survival( RFS) after 36 monthes of postoperative were 70 % 〠77 % respectively. Postoperative urinary continence(follow-up more than 90 days): there was no patient had complete urinary incontinence which need catheterization or pseudo catheterization at daytime. 8patients controled slightly worse(3 persons need more than 2 pieces of diaper),involuntary urine overflow often had been seen when they were acting or staying in supine position, but when they set down the urinary continence was better. 9 people completely was unable to control urination at night and need pseudo-catheterization.16 persons need more than 2 pieces of diaper and 65 persons need less than 2 pieces of diaper. 3 patients had a lot of slime which caused difficult urination and can not completely drained, these patients need self-catheterization. The rate of urinary continence: day 95%, night 72%. 30 patients had urodynamic testing over 1 year after surgery: the max flow rate was 4.9-22.7ml/s, the average flow rate was 13.5 ml/s, the bladder capacity was 137-471 ml, the average bladder capacity was 363 ml, the bladder voiding pressure was 29-68cmH2 O, the average contract pressure was41.1cmH2 O, bladder pressure was 0.59-14.21cmH2O(the mean pressure was13.6cmH2O), the volume of residual urine was 0-204ml(the mean volume was39.5ml). There were 8 patients had a total of 11 obstructed ureters(one had bilateral ureteral nipple adhesion, one had bilateral ureteral calculus, one had tumer recurrence, the others had lower ureteral obstruction). There was 1 patient had neobladder calculus and 2 patients had recurrent urinary tract infections Conclusions: Laparoscopic resection of bladder cancer(LRC) + pelvic lymphadenectomy is the safe and effective surgical methods of muscular invasion-run type and high-risk of bladder cancer; ileal orthotopic neobladder is one of the main surgery of urinary diversion, it has nearly nomal urodynamic features. The surgery has many postoperative complications that need regular follow-up and to be fixed in time... |
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