Đánh giá kết quả điều trị ung thư bàng quang xâm lấn lớp cơ bằng phẫu thuật cắt bàng quang triệt căn để lại vỏ tuyến tiền liệt kết hợp nạo hạch chậu mở rộng và tạo hình bàng quang từ hồi tràng

2021 ◽  
Author(s):  
Ngoc Khanh Tran
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Statistical Significance ◽  
Pelvic Lymphadenectomy ◽  
Invasive Bladder Cancer ◽  
Urinary Continence ◽  
Control Group ◽  
Ileal Neobladder ◽  
Estimated Blood Loss ◽  
Orthotopic Ileal Neobladder

TÓM TẮT Đặt vấn đề: Phẫu thuật cắt bỏ toàn bộ bàng quang được xem là phẫu thuật tiêu chuẩn đối với ung thư bàng quang xâm lấn. Tạo hình bàng quang mới từ hồi tràng, cũng như nạo vét hạch nhằm tránh di căn và nâng cao tỉ lệ sống sau 5 năm rất quan trọng. Bên cạnh đó, chất lượng cuộc sống của bệnh nhân sau phẫu thuật cũng rất đáng quan tâm. Mục tiêu: Đánh giá kết quả điều trị ung thư bàng quang xâm lấn lớp cơ bằng phẫu thuật cắt bàng quang triệt căn để lại vỏ tuyến tiền liệt kết hợp nạo hạch chậu mở rộng và tạo hình bàng quang từ hồi tràng. Nội dung và phương pháp nghiên cứu: Nghiên cứu tiến cứu, mô tả lâm sàng không nhóm chứng 43 bệnh nhân nam được chẩn đoán ung thư bàng quang xâm lấn (cT2a - T4aN0M0), được phẫu thuật cắt bàng quang triệt căn để lại vỏ tuyến tiền liệt, nạo hạch chậu mở rộng và tạo hình bàng quang mới từ hồi tràng từ tháng 1/2015 đến 12/2020 tại khoa ngoại Tổng hợp BVTW Huế. Kết quả: Thời gian phẫu thuật trung bình: 213,5 ± 29,7 phút. Lượng máu mất trung bình: 130 ± 90 ml. Lấy được 11,5 ± 4,5 hạch. Thời gian nằm viện trung bình: 17,12 ± 6,45 ngày. Tỷ lệ biến chứng sớm sau mổ 32,6%. Đa số bệnh nhân khi xuất viện đều tiểu được nhưng tia tiểu yếu, tiểu són, thể tích nước tiểu ít dưới 150 ml.Thể tích bàng quang tăng có ý nghĩa qua các lần tái khám (p < 0,05). Tỷ lệ kiểm soát tiểu tiện ban ngày: 97,2% sau 6 tháng. 1/43 tái phát tại miệng nối bàng quang - niệu đạo sau 4 tháng. 7 trường hợp tử vong do ung thư tiến triển. Kết luận: Cắt bàng quang triệt căn để lại vỏ tuyến tiền liệt, nạo hạch chậu mở rộng và tạo hình bàng quang mới từ đoạn ruột non theo phương pháp Hautmann - Studer vẫn giải quyết triệt để vấn đề ung thư học, giảm khả năng tái phát di căn hạch, bệnh nhân vẫn còn khả năng tình dục và tiểu tự chủ sau mổ. ABSTRACT OUTCOMES OF INVASIVE BLADDER CANCER TREATED BY PROSTATE SPARING RADICAL CYSTECTOMY WITH EXTENDED PELVIC LYMPHADENECTOMY AND ORTHOTOPIC ILEAL NEOBLADDER Background: Radical cystectomy is considered a “gold standard” procedure to treat invasive bladder cancer. Orthotopic ileal neobladder after cystectomy as well as lymphadenectomy, which avoids metastasis and enhances postoperative 5 - years survival rate are important. Moreover, the quality of life after this kind of surgery is a great concern. Purpose: Evaluating results of treatment of invasive bladder cancer by prostate sparing radical cystectomy with extended pelvic lymphadenectomy and orthotopic ileal neobladder. Material and Method: Prospective and descriptive clinical study without a control group in 43 males who were diagnosed with invasive bladder cancer (cT2a - T4aN0M0), they underwent prostate sparing radical cystectomy with extended pelvic lymphadenectomy and orthotopic ileal neobladder, from 1/2015 to12/2020 at Department of General Surgery, Hue Central Hospital. Results: The operative time: 213,5 ± 29,7 min. The estimated blood loss: 130 ± 90 ml. The mean number of lympho nodes which is conducted lymphadenectomy: 11,5 ± 4,5. The length of hospital stay: 17,12 ± 6,45 days. Early complication rate: 32,6%. The majority of patients who were discharged from the hospital passed urine with urinary incontinence, weak urine stream and voided volume < 150ml. The volume of the neobladder increased with statistical significance through follow - up examinations (p < 0,05). The daytime continence rate was 97,2% after 6 months. 1/43 case recured at cystourethral anastomosis after 4 months. 7 cases dead due to cancer progression. Conclusion: Prostate sparing radical cystectomy with extended pelvic lymphadenectomy and Hautmann - Studer orthotopic ileal neobladderstill thoroughly solve oncologic issues, reduce the possibility of lymph node metastasis recurrence. The patient still has the sexual ability and urinary continence after this procedure. Keywords: Extended pelvis lymphadenectomy; invasive bladder cancer; radical cystectomy; orthotopic ileal neobladder.

Original Articles: Bladder Cancer: Orthotopic Ileal Neobladder in Female Patients After Radical Cystectomy: 2-Year Experience

1995 ◽  
Vol 153 (3S) ◽  
pp. 956-958 ◽  
Author(s):  
Antonio Cancrini ◽  
Piero De Carli ◽  
Hassan Fattahi ◽  
Vincenzo Pompeo ◽  
Ruggero Cantiani ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Ileal Neobladder ◽  
Female Patients ◽  
Orthotopic Ileal Neobladder

scholarly journals Comparative analysis of the clinical effect and safety of Laparoscopic Radical Cystectomy + Orthotopic Ileal Neobladder and Open Surgery

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Yuan-hua Liu ◽  
Hai-tao Dai ◽  
Chang-mao Liu ◽  
Jiang Zheng
Keyword(s):  
Comparative Analysis ◽  
Postoperative Complications ◽  
Radical Cystectomy ◽  
Open Surgery ◽  
Clinical Effect ◽  
Bladder Pressure ◽  
Control Group ◽  
Observation Group ◽  
Ileal Neobladder ◽  
Orthotopic Ileal Neobladder

Objectives: To explore the clinical effect and safety of laparoscopic radical cystectomy + orthotopic ileal neobladder and open surgery. Methods: The study was conducted at Jingzhou First People’s Hospital from January 2017 to July 2018. In this study 87 patients undergoing radical cystectomy + orthotopic ileal neobladder were chosen and classified into an observation group (48 cases) and a control group (39 cases) according to the surgical methods. The observation group underwent laparoscopic surgery, while the control group underwent open surgery. Perioperative period and prognostic conditions were compared in both groups. Results: The intraoperative bleeding amount obviously decreased. The recovery time of gastroenteric function and postoperative hospitalization time were significantly shortened. Postoperative pain was significantly alleviated. Compared with the control group, the observation group showed significant differences (P<0.05). The time, amount and difference in pelvic lymph node dissection in both groups were not significantly different (P>0.05). The differences in both groups in terms of the daytime/nighttime urinary continence rate, maximum urinary flow rate, internal bladder pressure, maximum bladder pressure during urination, internal urethral pressure, bladder capacity, and residual urine volume six months after the operation were not statistically significant (P>0.05). There was no significant difference in postoperative complications, including urinary fistula, bleeding, urinary tract infection, pulmonary infection, dysuria, lymphatic leakage, ureterostenosis, or relapse (P>0.05). The ileus incidence rate in the observation group was obviously lower than that in the control group, and the difference was statistically significant (P<0.05). Conclusion: Laparoscopic radical cystectomy + orthotopic ileal neobladder has the characteristics of limited trauma, a minimal amount of bleeding and a fast recovery. The functions of orthotopic neobladders are good, and the occurrence rate of postoperative complications is low. In addition, body immunity is protected. Hence, this procedure deserves to be promoted clinically. doi: https://doi.org/10.12669/pjms.37.1.2273 How to cite this:Liu YH, Dai HT, Liu CM, Zheng J. Comparative analysis of the clinical effect and safety of Laparoscopic Radical Cystectomy + Orthotopic Ileal Neobladder and Open Surgery. Pak J Med Sci. 2021;37(1):59-64. doi: https://doi.org/10.12669/pjms.37.1.2273 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

RESULTS OF EXTENDED PELVIS LYMPHADENECTOMY IN RADICAL CYSTECTOMY PATIENTS FOR TREATMENT INVASIVE BLADDER CANCER

2017 ◽  
pp. 95-100
Author(s):  
Luong Vinh Le ◽  
Van Tung Hoang ◽  
Ngoc khanh Tran ◽  
Thanh Liem Ngo ◽  
Dinh khanh Le
Keyword(s):  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Cystectomy ◽  
Pelvic Lymphadenectomy ◽  
Invasive Bladder Cancer ◽  
Postoperative Survival ◽  
Lymph Node Count ◽  
Node Positive ◽  
Lymph Node Positive ◽  
Centre Hospital

Background: For long time the standard lymphadenectomy is the part of radical cystectomy surgery for treament invasive bladder cancer. Some new research show the good result of extended pelvic lymphadenectomy in improving postoperative survival. Purpose: Report techniques and results of extended pelvic lymphadenectomy in radical cystectomy for invasive bladder cancer. Material and method: Prospective descriptive study on 38 extended pelvic lymphadenectomy patients from January 2013 to April 2017 at Hue Centre Hospital. Results: Mean of age: 63.45 ± 12.5 years old. Female/man: 3/38. Lymph nodes metastasis6/38 patients, 4 obturator lymph node positive and 2common iliac vessels lymph node positive. Mean time of pelvic lymphadenectomy: 78 ± 43 mins. Mean of blood loss: 120 ± 55ml. Mean of lymph node count: 13 ± 4. Conclusion: Extended pelvic lymphadenectomy should be perform for all patients radical cystectomy to improve postoperative survival and It is safe when perform at a good surgery centre with experienced surgeon. Key words: Extended pelvic lymphadenectomy; invasive bladder cancer; Radical cystectomy

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