膀胱全切N形回肠原位代膀胱术15例疗效观察

Radical cystectomy with Nshaped ileal orthotopic neobladder： a report of 15 cases

目的评价膀胱全切、N形回肠原位代膀胱术的临床效果。方法回顾分析2002年2月至2007年5月我院因膀胱肿瘤行膀胱全切回肠原位代膀胱术15例患者的临床资料。结果手术时间6～8h，平均（7±1）h；术中出血300—1100ml，平均（550±80）ml；随访5～67个月，平均（29±6．3）个月，患者均无瘤存活。新膀胱容量平均260ml，最大尿流率平均（16．8±3．2）ml。剩余尿平均（50±15）ml。回肠原位新膀胱控尿、排尿良好，术后静脉尿路造影、B超检查未见上尿路扩张，膀胱造影未发现输尿管返流，血生化检查正常，未发现新膀胱或尿道肿瘤复发。结论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，可明显提高患者术后的生活质量，是一种较理想的膀胱替代术式。

Objective To evaluate the efficacy of N-form ileal orthotopic neobladder. Methods From February 2002 to May 2007, 15 cases of bladder tumor were treated with radical cystectomy and ileal orthotopic neobladder. Results Operating time ranged 6 to 8 hours with mean of 7 hours. The blood loss was 300 ml to 1100 ml （mean 550 ml）. All of these patients were followed up for 5 to 67 months with mean of 29 months. All patients survived with no recurrences. The average capacity of the urinary reservoir, peak urinary flow rate and resilualurine volume were 260ml, 16.8ml/s and 50 ml respectively. All patients had excellent urine control and maturation. Patient with upper urinary tract hydrocele was not found by BUS and IVU. Voiding cystography revealed no currence of ureterovesical reflux. Renal function, electrolyte and other laboratory findings were normal. No patient suffered from tumor recurrence in neobladder or urethral. Conclusion Ileal orthotopic neobladder continent reservoir, characterized by low pressure, large capacity, orthotopic continent urination, is an ideal form of orthotopic bladder.