部分胃体-窦部代膀胱术的临床应用及长期随访

Clinical application and long-term follow-up of the substitution of a segmental sinus-body of stomach for urinary bladder

目的探讨部分胃体-窦部代膀胱术的临床应用价值。方法回顾性分析30例胃代膀胱术患者的临床资料、实验室检查、影像学检查、膀胱镜及尿动力学检查结果。男17例，女13例。年龄21—69岁，平均55岁。原发病为膀胱癌24例，结核性膀胱挛缩6例。结果术后新膀胱贮尿功能良好，患者经尿道排尿，膀胱容量280—580ml，平均385ml；最大尿道压20—60cm H2O，平均49cm H2O；充盈期膀胱压5—15cm H2O，平均12cmH2O；最大膀胱压35—65cm H2O，平均55cmH2O；排尿期最大膀胱压28—60cm H2O，平均46cm H2O；最大尿流率10～28ml／s，平均18ml／s；剩余尿量5～85ml，平均20ml。随访9个月一24年，平均8．2年，无水、电解质代谢紊乱，无输尿管返流，无尿失禁及肾功能损害。4例出现会阴部、膀胱区疼痛；5例出现遗尿，术后3—6个月逐渐缓解；1例因膀胱结石再次手术。术后3．5年膀胱肿瘤复发1例，行经尿道膀胱肿瘤电切术。结论部分胃体一窦部代膀胱术后并发症少，相关生理指标接近正常。

Objective To evaluate the reconstruction of bladder using a segmental sinus-body of stomach on the basis of a clinical study. Methods We retrospectively reviewed the medical records, laboratory evaluations,imaging examinations,cystoscopy,urodynamic studies of 30 patients （17 men and 13 women;mean age,55 years;age range,21 -69 years） who underwent the reconstruction of bladder using a segmental sinus-body of stomach. Of the 30 patients, 24 had primary bladder cancer and 6 had tuberculous eontracture of the bladder. Results After operation, the new gastric bladder worked well in keeping and emptying urine. All patients micturated through the urethra. The bladder capacity was 280 - 580 ml （ mean, 385 ml）. The maximum urethral pressure was 20- 60 cm H2O （mean,49 cm H2O）. The filling bladder pressure was 5- 15 cm H2O （mean,12 cm H2O）. The maximum bladder pressure was 35 -65 cm H2O （mean,55 cm H2O）, and it was 28 -60 cm H2O （mean ,46 cm H2O） during urination. Qmax and post-void residual urine were 10 -28 ml/s （mean,18 mL/s） and 5 -85 ml （mean,20 ml）,respectively. Follow-up ranged from 9 months to 24 years （ mean,8.2 years）. There were no disturbance of water and electrolyte metabolism, no vesicoureteral reflux, no uracratia, and no damage to renal function. Complications included perineal and vesical pain in 4 cases, enuresis in 5 cases,which gradually remitted 3 -6 months after surgery, and bladder stone formation in 1 case, who underwent surgery again. At 3.5 years after surgery bladder tumor relapsed in 1 case,who then underwent transurethral resection of bladder tumor. Conclusions Our data show that the substitution of a segmental sinus-body of stomach for urinary bladder worth popularizing because of low complication rate and approximately normal urologic indexes.