改良Kock回肠代膀胱术51例报告

Modified Kock method of bladder reconstruction with ileum (report of 51 cases)

目的总结改良Kock回肠代膀胱术的优缺点,为临床推广应用提供客观依据。方法浸润性膀胱癌患者51例(T_2N_0M_037例,T_3N_0M_014例,病理分级Ⅱ～Ⅲ级),根治性膀胱全切术后,行改良Kock回肠膀胱术,包括缩短输入段回肠,重建储尿囊,代膀胱低位与尿道吻合,恢复原有排尿通道。结果51例手术时间5．5～8．5 h,平均6．5 h。术中出血量300～1200 ml,平均650 ml,术中输血31例。围手术期发生应激性溃疡6例；术后发生输尿管支架管拔除窦道漏尿1例,经再次引流后痊愈；其余44例均未出现严重并发症。术后6～8个月死于肿瘤广泛转移4例,余47例随访8～32个月存活,患者无腰腹胀痛、发热及血尿,B超及泌尿系造影显示储尿囊形态规则．2例患者存在输尿管返流,但无肾功能损害。术后6个月内患者白天均可完全控尿,夜间尿失禁6例。结论改良Kock回肠代膀胱术可显著提高患者生活质量,术后并发症少,符合生理性排尿,是一种较为理想的根治性膀胱全切术后尿流改道的方法。

Objective To investigate the clinical effects of the modified Kock method of bladder reconstruction with ileum, and to provide the objective basis for wide application of this technique. Methods A total of 51 patients with bladder cancer （T2N0M0 stage tumor in 37 cases, T2N0M0 stage tumor in 14; and pathologic grade Ⅱ - Ⅲ in all） were included. After radical cystectomy, modified Kock reconstruction of bladder with ileum was performed in them. The procedure consisted of preparing the segment of the ileum for reconstruction of the reservoir, anastomosing the low part of the neobladder with the urethra and regaining the original urinary conduit. Results The mean operative time was 6.5 h （ range, 5.5 - 8.5 h） ;mean intraoperative blood loss was 650 ml （ range,300 - 1200 ml） , with blood transfusion in 31 cases. Perioperative complications included stress ulcer in 6 cases and urinary leakage in 1. The other 44 cases had no severe complications. Four cases died of cancer metastasis at 6 - 18 months after operation. During a follow-up of 8-32 months,the other 47 cases recovered well and have been alive till now. Two cases had ureteral urine reflux with no impairment of renal function. The daytime urinary continent rate was 100% ;and nocturnal urinary incontinence occurred in 6 eases. Conclusions The modified Kock reconstruefion of bladder with ileum can improve the patients＇ quality of life with fewer complications, therefore is a better treatment choice for infiltrative bladder cancer after radical cystectomy.