関西医大における腹腔鏡下神経温存膀胱全摘除術および回腸新膀胱造設術の経験

Abstract

76歳男性.患者は膀胱癌に対する経尿道的腫瘍切除術, BCG療法後に萎縮膀胱となり, 頻尿, 尿失禁が悪化し, 術後1年目に著者らの施設へ受診となった.3回にわたる膀胱水圧拡張術を施行したところ, 症状は術後短期間軽快を示したものの, 再度悪化がみられた.そのため, 腹腔鏡下に神経温存膀胱全摘除術および回腸新膀胱造設術を行なった.尿失禁は軽度残存したが, 術翌日より歩行可能となり, 頻尿も改善した

Laparoscopic nerve-sparing radical cystectomy and construction of ileal neobladder was performed on a 76-year-old man with atrophic bladder after the intravesical instillation therapy for bladder cancer. Ileal neobladder was constructed by the combined extracorporeal technique through the camera port dilated to 45 mm. Operation time was 8 hours, with 3.5 hours for the nerve-sparing cystoprostatectomy, 2.5 hours for the extracorporeal neo-bladder construction and 2 hours for the laparoscopic urethra neo-bladder anastomosis and wound closing. The post-operative course was uneventful with minimum use of analgesia. This operation was minimally invasive therapy and from the functional aspect the potency was preserved. Although this method was technically challenging, various advantages can be promising for the patients compared to the standard open technique. Indication of this operation should be carefully expanded. Various methods, such as the complete intracorporeal technique and minimally invasive laparoscopic neobladder (MILaN) technique, have been reported for urinary diversion. In this report, we compared our method with other techniques.