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

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.

Neuroimaging Study Investigating the Supraspinal Control of Lower Urinary Tract Function in Man With Orthotopic Ileal Neobladder

Introduction: Recent studies employing functional imaging methodology have revealed reference brain regions of urinary tract function, namely, the midbrain periaqueductal gray matter, thalamus, and cingulate and prefrontal cortices. The orthotopic ileal neobladder is a desirable method for urinary diversion after radical cystectomy, but its supraspinal control remains unknown. We aimed to evaluate brain activity while maintaining urinary urgency and voluntary urinary control in male subjects with ileal orthotopic neobladders by performing functional MRI (fMRI) during a block design experiment.Materials and Methods: Patients were recruited at the Sun Yat-sen Memorial Hospital of the Sun Yat-sen University from October 2017 to May 2019. Two tasks were performed during fMRI scanning: (1) repeated infusion and withdrawal of sterile saline solution into and out of the neobladder to simulate urgency; and (2) repeated contraction of the pelvic floor muscle with a full neobladder to induce inhibition of micturition since the subjects were asked not to urinate. The obtained data were visualized and statistically analyzed.Results: Sixteen subjects were recruited in the study, and data were obtained from 10 subjects: mean age 60.1 years, average postoperative time 20.2 months, and daytime continence rate 100%. The parahippocampus, frontal lobe, vermis, and anterior cingulate cortex were activated with large bladder volumes, and the thalamus and caudate nucleus were deactivated during voluntary urinary control.Conclusion: A complex supraspinal program is involved during ileal orthotopic neobladder control, which is significantly different from that with normal bladders, in which the original intestine visceral volume sensation is preserved.

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

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.