腹腔鏡部分膀胱切除手術對於膀胱平滑肌瘤之治療
陳鴻毅、吳俊德、林政鋒、陳文祥、林承家
基隆長庚醫院 外科部 泌尿科
Different laparoscopic partial cystectomy approach for bladder leiomyoma
Hung-Yi Chen, Chun-Te Wu, Cheng-Feng Lin, Wen-Hsiang Chen, Cheng-chia Lin
Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung
Purpose:
Bladder leiomyoma is a relative rare bladder mesenchymal benign tumor. We present 3 different laparoscopic partial cystectomy (LPC) approaches as a treatment option in 3 patients.
Materials and Methods
Between July 2016 and Jan 2019, a total 3 patients diagnosed as bladder leiomyoma according to pre-op MRI and cystoscopy who underwent LPC through robot-assisted (RALPC), transperitoneal approach; conventional laparoscopy (LPC), transperitoneal; robot-assisted (RALPC), extraperitoneal route respectively. Preoperative, intraoperative, postoperative variables were retrospectively analyzed.
Result
The mean tumor size was 3.8cm, the tumor location and approach route is dome, RALPC, transperitoneal; posterior wall near dome, LPC, transperitoneal; anterior wall near bladder neck, RALPC. Two-layer cystorrhaphy after tumor resection was performed in all 3 patients, LPC took longest and RALPC with extraperitoneal approach took the shortest operative time (215 minutes vs. 92 minutes). No major complications (≥ Clavien grade 2) were reported. All patients removed the urethral catheter on postoperative day 7 after cystography without leakage. Pathology compatible with leiomyoma and no recurrent was observed currently. RALPC with extraperitoneal approach route has a lower risk of bowel injury or possible postoperative adhesion.
Conslusion
RALPC is an effective treatment option because of its delicate degree of freedom during suture technique. The extraperitoneal route is also feasible and minimal risk of intraperitoneal organ injury or postoperative adhesion if tumor located at bladder anterior wall..