保留神经的全膀胱切除术对盲结肠代膀胱控尿功能的影响

Effect of nerve-sparing cystectomy on postoperative continence after orthotopic bladder substitution

目的 探讨保留神经全膀胱切除术对盲结肠代膀胱控尿功能的影响。 方法 膀胱全切盲结肠代膀胱术共 73例 ,其中保留神经组 4 8例 ,非保留神经组 (对照组 ) 2 5例。术后随访 3～ 2 8个月 ,通过问卷和尿垫试验对比术后控尿能力。 结果 拔除尿管后 ,保留神经组白天和夜间可控率分别为 6 5 %和 4 0 % ;对照组为 34%和 2 6 %。术后达到白天和夜间可控所用的平均时间保留神经组分别为 2个月和 4个月 ;对照组为 5个月和 10个月。术后 12个月时 ,保留神经组白天和夜间可控率分别为 96 %和 87% ;对照组为 79%和 6 4 %。两组差异有显著性意义 (P <0 .0 1)。 结论 保留神经膀胱全切盲结肠代膀胱术可以提高术后控尿功能 ,减少尿失禁发生率。

Objective To examine the effect of nerve sparing cystectomy technique on postoperative continence after orthotopic bladder substitution. Methods A total of 73 consecutive male patients underwent cystectomy and construction of a colonic reservoir with low pressure.Of them nerve sparing were attempted in 48 cases (study group) and non nerve sparing in 25 (control group).The patients were followed up for 3 to 28 months.Postoperative continence was compared between the 2 groups through questionnaires and urinary pad test. Results After removal of the urinary catheter the continence rate was 65% in nerve sparing group and 34% in non nerve sparing group during the day;and it was 40% and 26%,respectively,at night.The mean time from post operation to continence during the day and at night in nerve sparing group was 2 and 4 months,respectively;while it was 5 and 10 months,respectively in non nerve sparing group.Twelve months after operation,the continence rate of nerve sparing group and non nerve sparing group was 96% and 79% during the day;and it was 87% and 64% at night,respectively.Continence differed significantly between the two groups (day, P =0.002;night, P =0.001). Conclusions Nerve sparing cystectomy is associated with improved urinary continence after orthotopic bladder substitution.