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Preliminary Efficacy of Combined Laparoscopy and Cystoscopy in the Treatment of Bladder Diverticula
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摘要:
目的 探索性分析膀胱镜联合腹腔镜切除术治疗膀胱憩室的疗效及其安全性。 方法 回顾性收集2007年3月至2022年9月北京协和医院行手术治疗膀胱憩室患者的临床资料, 根据术式其分为单纯开放手术/腹腔镜组、膀胱镜联合腹腔镜组。比较两组手术相关指标及并发症发生率。 结果 共入选符合纳入与排除标准的膀胱憩室患者11例, 包括单纯开放手术/腹腔镜组6例、膀胱镜联合腹腔镜组5例, 其憩室最大径分别为7.5(4.5, 11.5) cm、5.2(5.0, 7.9) cm, 憩室口直径分别为1.1(1.0, 1.6) cm、1.5(1.1, 1.8) cm。两组均顺利完成手术, 拔除尿管后均正常排尿; 随访6~60个月均无憩室复发。膀胱镜联合腹腔镜组与单纯开放手术/腹腔镜组的手术时间[150.0(142.5, 180.0) min比160.0(108.8, 300.0) min]、术中出血量[50.0(35.0, 50.0) mL比50.0(45.0, 62.5) mL]、引流管拔除时间[5.0(3.5, 5.5) d比4.5(4.0, 6.8) d]均相近; 相较于单纯开放手术/腹腔镜组, 膀胱镜联合腹腔镜组术后住院时间缩短[6.0(6.0, 8.5) d比9.5(7.0, 16.0) d], 尿管拔除时间延长[14.0(10.5, 14.0) d比11.5(6.5, 13.3) d]。膀胱镜联合腹腔镜组无并发症发生, 单纯开放手术/腹腔镜组2例出现术后并发症, 包括下肢深静脉血栓形成1例、术后高热1例。 结论 膀胱镜联合腹腔镜切除术治疗膀胱憩室可取得与单纯开放手术或腹腔镜手术相近的疗效, 且其安全性更高、患者术后恢复更快。 Abstract:Objective To exploratively analyze the efficacy and safety of combined laparoscopy and cystoscopy in the treatment of bladder diverticula. Methods Clinical data of patients who received bladder diverticulectomy in Peking Union Medical College Hospital from March 2007 to September 2022 were retrospectively collected.The patients were divided into open/laparoscopy alone group and combined laparoscopy and cystoscopy group based on surgical approach.Surgery-related outcomes and complication rates were compared. Results A total of 11 patients with bladder diverticula who met the inclusion and exclusion criteria were enrolled in thestudy, including 6 patients in the open/laparoscopy alone group and 5 patients in the combined laparoscopy and cystoscopy group.The median maximum diameter of diverticula in the open/laparoscopy alone group and combined laparoscopy and cystoscopy group were 7.5(4.5, 11.5) cm and 5.2(5.0, 7.9) cm, respectively, and the median diameter of diverticula neck were 1.1(1.0, 1.6) cm and 1.5(1.1, 1.8) cm, respectively.Operations were successfully performed in both two groups and the patients had normal urination after drawing the catheter.No recurrence of bladder diverticulum at 6 to 60 months of follow-up.The median operative time[150.0(142.5, 180.0) min vs. 160.0(108.8, 300.0) min], blood loss[50.0(35.0, 50.0) mL vs. 50.0(45.0, 62.5) mL]and indwelling time of drainage tube[5.0(3.5, 5.5) d vs. 4.5(4.0, 6.8) d]were similar between the two group.Compared to the open/laparoscopy alone group, the combined laparoscopy and cystoscopy group had a shorter postoperative hospital stay[6.0(6.0, 8.5) d vs. 9.5(7.0, 16.0) d]and longer indwelling time of urinary catheter[14.0(10.5, 14.0) d vs. 11.5(6.5, 13.3) d].No complications occurred in the combined laparoscopy and cystoscopy group.In the open/laparoscopy alone group, 2 patients underwent postoperative complications, including 1 patient with deep vein thrombosis of the lower extremities and 1 patient with hyperpyrexia. Conclusion Preliminary results show that cystoscopy combined with laparoscopic resection for bladder diverticula can achieve similar outcomes as open surgery alone or laparoscopic surgery, and with greater safety and faster postoperative patient recovery. -
Key words:
- bladder diverticula /
- laparoscopy /
- cystoscopy /
- efficacy /
- safety
作者贡献：魏梦超负责研究设计、数据收集与分析、论文撰写；王文达、王诗钧、张志军提出修改意见；文进负责论文修订。利益冲突：所有作者均声明不存在利益冲突 -
图 1 双镜联合组术中操作展示
A.显露膀胱后(a)，术中膀胱镜实时导航膀胱憩室位置；B.将憩室(a)与正常膀胱壁(c)分离，提起憩室颈口(b)，膀胱镜勾状电极切开憩室口；C.腹腔镜下可见膀胱镜勾状电极切开憩室口(a)；D.术中膀胱镜光源实时导航缝合膀胱壁(a)，并牵开子宫(b)
表 1 单纯开放手术/腹腔镜组与双镜联合组患者基线临床资料
指标 单纯开放手术/腹腔镜组(n=6) 双镜联合组(n=5) 男性[n(%)] 3(50.0) 4(80.0) 年龄[M(P25, P75)，岁] 69.5(56.8，76.8) 67.0(53.5，74.0) 继发性憩室[n(%)] 2(33.3) 4(80.0) 单发憩室[n(%)] 2(33.3) 1(20.0) 憩室位置[n(%)]* 膀胱后壁 4(66.7) 5(100) 膀胱前壁/侧壁 2(33.3) 0(0) 憩室最大径[M(P25, P75)，cm] 7.5(4.5，11.5) 5.2(5.0，7.9) 憩室口直径[M(P25, P75)，cm] 1.1(1.0，1.6) 1.5(1.1，1.8) 有既往盆腔手术史[n(%)] 1(16.7) 2(40.0) 有反复下尿路症状[n(%)] 5(83.3) 5(100) 有反复泌尿系感染[n(%)] 4(66.7) 3(60.0) 有反复尿潴留[n(%)] 2(33.3) 2(40.0) 尿培养阳性[n(%)] 3(50.0) 3(60.0) *多发憩室者以最大憩室的位置为准 
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表 2 单纯开放手术/腹腔镜组与双镜联合组患者手术相关指标比较
指标 单纯开放手术/腹腔镜组(n=6) 双镜联合组(n=5) 手术时间[M(P25, P75)，min] 160.0(108.8，300.0) 150.0(142.5，180.0) 术中出血量[M(P25, P75)，mL] 50.0(45.0，62.5) 50.0(35.0，50.0) 引流管拔除时间[M(P25, P75)，d] 4.5(4.0，6.8) 5.0(3.5，5.5) 尿管拔除时间[M(P25, P75)，d] 11.5(6.5，13.3) 14.0(10.5，14.0) 术后住院时间[M(P25, P75)，d] 9.5(7.0，16.0) 6.0(6.0，8.5) 并发症[n(%)] 2(33.3) 0(0)
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