膀胱全切回肠原位代膀胱15例疗效观察

Radical cystectomy with ileal orthotopic neobladder:report of 15 cases

目的评价膀胱全切除回肠原位代膀胱术的效果.方法回顾分析1999年8月至2005年3月膀胱肿瘤行膀胱全切原位回肠代膀胱术15例的临床资料. 结果所有病人均得到随访2个月～67个月,平均20个月,患者除1例外均无瘤存活.手术时间7～9 h,平均8 h,术中出血800～1 100 ml;平均960 ml;代膀胱容量平均300 ml;最大尿流率平均15 ml·s-1;剩余尿平均26 ml.代膀胱排尿状态良好,有一定的并发症出现值得注意.结论膀胱全切回肠原位代膀胱手术具有膀胱容量大,内压低,正位排尿,可控性能好等优点,是一种较理想的膀胱替代术式.

Aim To evaluate the efficacy of W form ileal orthotopic neobladder. Methods 15 cases of bladder tumor treated from August 1999 to March 2005 with radical cystectomy and ileal orthotopic neobldder were studied retrospectively. Results All of these patients have been followed up for 2 to 67 months with a mean of 20 months. Operating time ranged 7 to 9 hours with a mean of 8 hours ; The blood loss was 800 to 1100 ml with a mean of 960 ml;All patients were survival with no recurrences except 1 case：Urodynamics carried out after operation showed that the average capacity of the urinary reservoir ,the peak urinary flow rate and the residual urine volume were 300 ml, 15 ml·s^-1 and 26 ml. Good urinary, stream was reported. A little operative complications occurred. Conclusions The ileal orthotopic neobladder continent reservoir might be an ideal form of orthotopic bladder replacement ,characterized by low pressure ,large capacity,orthotopic continent urination.