可控性肠代膀胱术的疗效观察

A follow -up study of the continent urinary reservoir

目的:探讨去带可控性盲升结肠膀胱术、回肠可控膀胱术及回肠原位新膀胱术的临床疗效。方法:对 14例患者采用去带可控性盲升结肠膀胱术,8例采用回肠可控膀胱术,12例采用回肠原位新膀胱术,对3种术式的并发症、可控性、尿容量、排尿次数及间隔时间、肾功及肾积水情况进行对比分析。结果:1例回肠可控膀胱术及2 例回肠原位新膀胱术可控性差,但随容量增加及经肛门括约肌训练,溢尿逐渐消失,1例回肠原位新膀胱术患者发生漏尿,1个月后自愈。3例回肠原位新膀胱术患者发生排尿困难,经扩张后症状消失。术后半年,去带可控性盲升结肠膀胱术容量平均400 ml左右,4 h导尿1次,最大容量700-1 200 ml;回肠可控膀胱术容量300-400 ml, 2．5-4 h导尿1次,最大容量400-1 000 ml左右;回肠原位新膀胱术容量250-300 ml左右,3-4 h排尿1次,最大容量300-100 ml。结论:在严格选择适应证的基础上,应先选择回肠原位新膀胱术,有利于改善病人生活质量。其次可选择去带可控性盲升结肠膀胱术,此术式可建立低压、大容量的储尿囊。

Objective： To investigate the clinical effect of the three continent urinary reservoir. Methods. To compare the 14 detenia cecocolic continent reservoir, 8 ileal continent reservoir and 12 ileal neobladder on postoperative compication, continence capacity, voiding times, renel function, and hydronephrosis. Results： One ileal continent reservoir and two ileal neobladder＇s continence were not satisfactory, but following the volume increasing and anal sphincter self-training, the leakage of urine stopped gradually. Three ileal neobladder had dysuria, it were disapper by dilation urethra. In half of year, the detenia cecocolic continent reservoir had average volume 400 ml, voiding 4 h per hour, the maximum volume 700-1 200 ml; the ileal continent reservoir had average volume 300-400 ml , voiding 2.5-4 h per times , the maximum volume 400-1 000 ml; the ileal neobladder had average volume 250-300 ml , voiding 3-4 h per times, the maximum volume 300-400 ml. Conclusion： On the basis of the strictly selecting patients, we think that it is better to choose ileal neobladder for bladder cancer, because it can achieve the normally life. If it is not , then we can choose the low pressure, high volume reservoir, the detenia cecocolic continent reservoir for bladder cancer.