原位可控性去带盲升结肠膀胱术

Orthotopic continent detenial cecum-ascending colon neobladder

目的:探讨原位可控性去带盲升结肠膀胱术的手术方法及临床疗效.方法:对13例膀胱癌患者行膀胱癌根治性切除术,并应用去带盲升结肠作贮尿囊行原位膀胱重建术.结果:13例患者中,1例出院后因心血管疾病死亡,余12例均获随访至今.术后早期均出现尿频,6个月后自控排尿稳定.生存的12例均无严重的并发症.术后6个月新膀胱平均容量390 ml,最大尿流率13.2 ml/s,新膀胱充盈期内压(卧位)1.41～3.38 kPa,剩余尿量30 ml以下.患者自我感觉良好,生活质量提高.结论:原位可控性去带盲升结肠膀胱术具有容量大、内压低、可控性好、抗反流、经尿道排尿、并发症少等优点,易于患者接受.

Objective:To investigate the procedures and the clinical results of orthotopic continent detenial cecum-ascending colon neobladder after total cystectomy.Methods:Between December 2001 and August 2004, 13 41~74-year-old patients (10 men 3 women) with bladder tumors underwent total cystectomy with orthotopic continent detenial cecum-ascending colon neobladder. Clinical data were analysed retrospectively.Results:Success of treatment has been achieved in all. The patients have been followed up to now(mean period of 17.5 months, range 3～32 months). Continence of urination has been excellent. More than 6 months after operation ,the capacity of the urinary reservoir is 220～450 ml ( averaged capacity 390 ml).The intrareservoir pressure is 1.41～3.38 kPa. And there were no serious complications.Conclusions:Continent detenial cecum-ascendin colon neobladder is fairly good procedure for the reconstruction of urinary reservoir after total cystectomy. It can make patients with radical cystectomy urinate continently through urethra without suffering from other urinary diversion and obviously improve postoperative patients life qualities.