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目的:介绍一种改良的手术方法——膀胱镜引导下经耻骨上气膀胱膀胱肿瘤切除术(CRBTSP),用以治疗电切镜不能插入膀胱行电切操作膀胱癌患者。方法:1例膀胱癌患者因F26、F24电切镜均难以通过尿道,取F19硬性膀胱镜插入膀胱,取5mm Trocar自耻骨上2横指处穿刺置入膀胱。建立CO2气膀胱,自Trocar插入腹腔镜单极电凝钩,在膀胱镜直视下行膀胱肿瘤切除术。记录手术时间,出血量,肾功电解质,术后住院时间,并发症,拔管时间、切口愈合情况。结果:手术过程顺利,肿瘤切除过程大约10min,基本无出血。术后肾功电解质正常,尿管留置时间为5天,拔管后患者排尿良好。病理报告示低级别乳头状尿路上皮癌。术后无明显并发症出现,切口愈合良好。住院时间5天,定期灌注,随访3个月,肿瘤无复发。结论:CRBTSP技术上可行,这种方法可应用于电切镜不能插入膀胱的膀胱肿瘤患者。
OBJECTIVE: To introduce a modified surgical approach, cystoscope-guided suprapubic bladder cancer (CRBTSP) for the treatment of patients with bladder cancer who can not be inserted into the bladder undergoing resection of the bladder. Methods: One case of bladder cancer because of F26, F24 resectoscope are difficult to pass through the urethra, take F19 rigid cystoscopy into the bladder, 5mm Trocar from the suprapubes 2 transverse puncture puncture into the bladder. CO2 gas bladder was established, laparoscopic monopolar coagulation hook inserted from Trocar, bladder tumor resection under cystoscopy. The operation time, blood loss, renal electrolytes, postoperative hospital stay, complications, extubation time and incision healing were recorded. Results: The procedure was successful. The procedure of tumor resection was about 10 min with no bleeding. Postoperative renal Electrolytes normal catheter indwelling time of 5 days after extubation in patients with good urination. Pathological reports showed low-grade papillary urothelial carcinoma. No significant postoperative complications, incision healed well. Hospitalization time of 5 days, regular perfusion, followed up for 3 months, no recurrence of the tumor. Conclusion: CRBTSP is technically feasible. This method can be applied to patients with bladder cancer who can not insert bladder into the resectoscope.