本文選題：膀胱癌　切入點(diǎn)：腹腔鏡根治性膀胱切除術(shù)　出處：《昆明醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過探討減少腹腔鏡根治性膀胱切除術(shù)(Laparoscopic Radical Cystectomy,LRC)出血的方法,并對現(xiàn)有手術(shù)方法進(jìn)行改進(jìn),建立規(guī)范的手術(shù)操作流程,以縮短LRC的手術(shù)時(shí)間、減少術(shù)中出血、降低手術(shù)難度、縮短學(xué)習(xí)曲線,促進(jìn)規(guī)范化LRC術(shù)式的推廣和應(yīng)用。 方法：對2012年6月到20]4年1月昆明醫(yī)科大學(xué)第二附屬醫(yī)院泌尿外科三病區(qū)的62例男性膀胱癌患者行經(jīng)改良后的腹腔鏡根治性膀胱切除術(shù),具體方法為：游離輸尿管；結(jié)扎髂內(nèi)動(dòng)脈臍動(dòng)脈分支；游離膀胱、前列腺后間隙；標(biāo)準(zhǔn)法清掃盆腔淋巴結(jié)；切開盆內(nèi)筋膜,游離前列腺的雙側(cè)面；結(jié)扎和切斷膀胱后韌帶和前列腺側(cè)血管蒂；游離膀胱前間隙；縫扎恥骨前列腺韌帶；游離、切斷前列腺尖部尿道；逆行游離前列腺后壁。利用SPSS17.0軟件對根治手術(shù)時(shí)間、術(shù)中出血量、淋巴結(jié)清掃數(shù)目進(jìn)行統(tǒng)計(jì)分析,評價(jià)手術(shù)的療效及安全性。 結(jié)果：62例根治手術(shù)均在腹腔鏡下成功完成,無中轉(zhuǎn)開放手術(shù)。膀胱根治性切除術(shù)手術(shù)時(shí)間140-210min,平均170±19.5min:LRC術(shù)中出血量30ml-600ml,平均160±68.6ml；術(shù)中、術(shù)后無輸血病例。術(shù)后組織病理檢查示手術(shù)切緣全為陰性,盆腔淋巴結(jié)清掃數(shù)目4-21個(gè),平均15.98±2.8個(gè)。圍手術(shù)期無死亡病例,無直腸損傷、盆腔血管損傷病例。 結(jié)論：通過對手術(shù)步驟的科學(xué)設(shè)計(jì)及操作方法的改進(jìn),可有效提高LRC手術(shù)質(zhì)量、減少術(shù)中出血、降低手術(shù)并發(fā)癥、縮短學(xué)習(xí)曲線。
[Abstract]:Objective: to study the method of reducing the bleeding of laparoscopic Radical cystectomy (LRC), and to establish a standard procedure of operation to shorten the operation time of LRC and reduce the bleeding during operation. To reduce the difficulty of operation, shorten the learning curve and promote the popularization and application of standardized LRC operation. Methods: from June 2012 to January, 62 male patients with bladder cancer were treated with modified laparoscopic radical cystectomy in the third ward of Urology, second affiliated Hospital of Kunming Medical University. The specific methods were as follows: free ureter; Ligation of umbilical artery branch of internal iliac artery; free bladder, posterior prostatic space; standard method for pelvic lymph node dissection; incision of intrapelvic fascia, bilateral side of free prostate; ligation and amputation of posterior bladder ligament and prostatic collateral vessel pedicle; Free anterior space of bladder; suture of pubic prostatic ligament; free, transected prostatic apical urethra; retrograde free prostatic posterior wall. SPSS17.0 software was used to analyze the time of radical operation, the amount of intraoperative bleeding, and the number of lymph nodes dissected. To evaluate the efficacy and safety of the operation. Results all of the 62 cases of radical resection were successfully performed under laparoscopy, and no conversion to open surgery was performed. The operative time of radical cystectomy was 140-210 min (mean 170 鹵19.5 min) with an average bleeding volume of 30ml-600ml (160 鹵68.6ml) during the operation. There were no blood transfusion cases after operation. The postoperative histopathological examination showed that the surgical margin was negative, the number of pelvic lymph node dissection was 4-21 (mean 15.98 鹵2.8). There were no death cases, no rectal injury and pelvic vascular injury cases in perioperative period. Conclusion: through the scientific design of the operation steps and the improvement of the operation method, the quality of LRC operation can be improved effectively, the bleeding during operation can be reduced, the complications of operation can be reduced, and the learning curve can be shortened.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.14

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