保留前列腺远端包膜在全膀胱切除肠代膀胱术中的应用

Radical cystectomy with distal prostate capsule sparing for bladder cancer

目的 探讨膀胱癌患者根治性全膀胱切除术中保留前列腺远端包膜的价值。 方法5 6例患者均为男性 ,平均年龄 6 2岁。其中膀胱移行细胞癌 5 3例 ,鳞状细胞癌 3例 ;原发肿瘤 4 0例 ,复发肿瘤 16例。浅表性肿瘤 2 7例 ,浸润性肿瘤 2 9例。常规盆腔淋巴清扫术后 ,行保留前列腺远端包膜的全膀胱前列腺切除术。分别应用去管化回结肠或回肠作原位代膀胱 2 0例和 36例。随访观察手术效果和生活质量。 结果 回结肠代膀胱和回肠代膀胱的平均手术时间分别为 35 0和 380min ,术中出血量分别为 5 80和 5 4 0ml。病理报告pT1N0 2 8例 ,pT2 N0 2 5例 ,pT3 N+3例。平均随访 4 2个月 ( 4～ 10 2个月 ) ,3例T3 N+者分别于术后 8、11、19个月死于癌肿 ,死于其他病变者 5例。随访 1年时 ,两种代膀胱白天控尿率分别为 94 % ( 17/18)和 10 0 % ( 30 /30 ) ,夜间排尿 1～ 2次后 ,保持干燥者占 96 %( 4 6 /48)。术后最大尿流率分别为 ( 15 .8± 2 .6 )ml /s和 ( 14 .7± 3.2 )ml/s。随访 5年以上者 2 8例 ,肿瘤特异 5年生存率T1N0 为 94 % ( 15 /16 ) ,T2 N0 为 83% ( 10 /12 )。术前勃起功能正常 31例中 ,术后维持正常勃起 2 3例 ( 74 % )。 结论 保留前列腺远端包膜的膀胱癌肠代膀胱术 ,能有效保留神经和括约肌功能 ,提高?

Objective To evaluate the clinical value of cystectomy with prostate capsule sparing in orthotopic bladder replacement for bladder cancer. Methods A total of 56 male patients (mean age,62 years) with bladder cancer were included.Of them 40 cases were of primary tumors and 16 were of recurrent ones.Pathology by cystoscopy and biopsy showed transitional cell carcinoma in 53 cases and squamous cell carcinoma in 3.According to the analysis of B ultrasound,CT,MRI and cystoscopy, they were clinically diagnosed as recurrent multiple superficial tumors (n=27) and invasive tumors (n=29).Radical cystectomy with prostate capsule sparing was performed on them.Detubularized ascending colon (20 cases) or ileal segment (36 cases) was used to form a neobladder,which was anastomosed with distal portion of prostate capsule. Results Mean operative time of ascending colonic neobladder and ileal neobladder was 5 h 50 min and 6 h 20 min,with blood loss of 580 ml and 540 ml,respectively.Pathology showed pT 1N 0 in 28 cases,pT 2N 0 in 25 and pT 3N + in 3.During the follow up of 4 to 102 months (mean,42 months) 3 patients of pT 3N + died of bladder cancer and 5 died of other diseases.The cancer specific 5 year survival was 94% in cases of T 1N 0,83% in T 2N 0.At 1 year follow up,17 out of 18 patients (94%) with ascending colonic neobladder and 30 out of 30 patients (100%) with ileal neobladder were fully continent during the day,and 46 (96%) voided 1 to 2 times at night and could stay dry.Of 31 patients with preoperative adequate sexual function, 23 (74%) maintained potency postoperatively. Conclusions Radical cystectomy with distal prostate capsule sparing and reconstruction with an orthotopic neobladder is a relatively safe and reliable surgical procedure.It can improve the continence and potency without compromising the principle of tumor control.