低张力Roux-y乙状结肠新膀胱在尿流改道中的应用

Application of low tension Roux-y sigmoid neobladder in urine diversion

目的评价全膀胱切除后低张力抗尿粪逆流Roux-y乙状结肠新膀胱在尿流改道中的疗效。方法21例患有浸润性膀胱癌的患者施行了膀胱全切、低张力抗尿粪逆流Roux-y乙状结肠新膀胱术，术后随访8～79个月，平均36个月，尿动力学检查包括尿流率、残余尿、膀胱容量和充盈期膀胱压力测定。结果21例患者最大尿流率21．4～38．4ml／s，平均28．1ml／s，排尿时间9～28s，平均17s，无残余尿，尿意容量120～410ml，平均330ml，膀胱容量350～560ml，平均480ml，膀胱充盈期末压力14．2～18．6cmH2O（1cmH2O=0．098kPa），平均16．4cmH2O，最大排尿压23．6～63．4cmH2O，平均45．0cmH2O。结论低张力Roux-y乙状结肠新膀胱具有良好的储尿功能，是一种有效的可控尿流改道方法。

Objective To assess the therapeutic effects of low tension, anti-reflux Roux-y sigmoid neobladder. Methods A total of 21 patients （7 male and 14 female） were included, aged 43-87 years. All cases received radical cystectomy and low tension Roux-y sigmoid neobladder procedure for invasive bladder cancer were included in this study. The period of follow-up was from 8 to 79 months （ the average was 36 months）. Evaluations included urinary flow rate, postvoiding residual and filling cystometry. Results The mean maximum urinary flow rate, the voiding time and the postvoiding residual were 28. 1 ml/s （21.4-38.4 ml/s） ,17 s（9-28 s） and 0 ml respectively. The cystometric capacity was 480 ml（350-560 ml）. The volume of desire to void was 330 ml （120- 410 ml）. The bladder pressure was from 14.2 to 18.6 cm H2O （the average bladder pressure was 16.4 cm H2O） at high filling volumes. The maximum voiding pressuer was 45.0 cm H2O （23.6- 63.4 cm H2O ）. Condusions The Roux-y sigmoid neobladder has an adequate capacity at low pressure with a satisfactory continence, and it is an effective method for continent urinary diversion.