子宫圆韧带悬吊拖入式回结肠新膀胱术(附5例报告)

Cecal mucous down-pulled and Hunter's ligaments suspended orthotopic ileocolon continent urinary reservoir(report of 5 cases)

目的探讨拖入式回结肠新膀胱术的临床疗效.方法采用后尿道黏膜电切的根治性膀胱切除,子宫圆韧带悬吊的拖入式回结肠新膀胱术,治疗三角区浸润性膀胱癌5例.结果5例随访6～26个月.拔导尿管2、3周后,白天均可自主控制排尿;术后3个月4例无夜间遗尿;术后1 a 1例仍有少量夜间遗尿.4例术后6个月尿动力学检查膀胱容量371～447 mL,最大尿流率10.2～13.9mL/s,剩余尿量10～25 mL,尿道闭合压明显大于充盈期膀胱压力.复查血清电解质、肾功能正常,IVU检查及新膀胱造影未见积水与反流.膀胱镜下见膀胱颈平滑宽敞,后唇无抬高,无尿道肿瘤复发.结论拖入式回结肠新膀胱术方法简单有效,随诊排尿控尿满意,尿道无肿瘤复发,是治疗女性膀胱三角区浸润性膀胱癌的一种值得选择的原位新膀胱术式.

[Objective] To evaluate the modified orthotopic ileocolon continent urinary reservoir with cecal mucous down-pulled and Hunter′s ligaments suspended, after radical cystectomy for managing bladder cancer at triangle area in women. [Method] 5 cases of those mucous down-pulled and ligament suspended orthotopic ileocolon continent urinary reservoir after radical cystectomy with resection of the anterior wall of vagina were performed, reviewed and evaluated. [Result] 5 patients were followed up for 6 to 26 months. No serious operation related complications occurred. No daytime urinary incontinence, and nocturnal incontinence in one case. Urodynamics was carried out at 6 months after operation.The vesical capacity ranged from 371 to 447 mL and 4 intravesical pressure at maximum capacity ranged from 26 to 41 cmH2O. The urinary dynamic examination showed the maximum urinary flow rate varied from 13 to 20 mL/s and residual urine volume ranfed from 10 to 25 mL. IVU and cystography showed no renal hydrocele or reflux. Cystoscope show commodious and flat at the neck of the neobladder with no urethral recurrences.Their renal function and metabolism of electrolytes were normal. [Conclusion] Satisfactory urinary continence and voiding function is achieved with cecum mucous down-pulled and Hunter′s ligaments suspended orthotopic ileocolon continent urinary reservoir, which is believed an ideal procedure for lower urinary tract reconstruction after radical cystectomy in women of triangle area tumor.