女性可控性回肠膀胱术的远期疗效分析

Long-term outcome of female orthotopic ileal neobladder

目的探讨女性可控性回肠膀胱术的远期随访疗效。方法女性膀胱肿瘤患者19例，年龄45～66岁，平均52岁。病程16d-1．9年，平均4．4个月。临床表现均有间歇性无痛性全程血尿。肿瘤单发14例，多发5例。活检病理均为移行细胞癌。分级：G110例、G27例、G32例，UICC分期：pT15例、pT212例、pT3a 2例。肿瘤距膀胱颈部〉2cm。尿道无肿瘤，无尿失禁。19例均采用改良根治性膀胱全切除术，不切除子宫及阴道前壁，保护支配尿道的神经，清除盆腔脂肪淋巴组织，切除近端尿道0．8～1．2cm。应用末端回肠30cm制作新膀胱。原位尿道吻合。结果19例手术及术后恢复顺利。术后失访3例。16例随访6～102个月，平均71个月。无瘤存活15例，术后17个月死于心肌梗死1例。术后9个月昼、夜控尿率分别为100％（16／16）和93％（14／15）。术后9个月，15例行尿动力学测定，新膀胱容量（519．0±53．0）ml，残余尿量（29．2±4．9）ml，最大尿流率（18．6±2．8）ml／s；平均充盈压力和排尿压力分别为（16．7±3．5）和（53．0±5．0）cmH2O（1cmH2O=0．098kPa）。术后9个月IVU检查单侧上尿路轻度积水1例，血BUN、Cr、电解质及二氧化碳结合力均正常。肿瘤无复发。结论女性可控性回肠膀胱术后控尿功能良好，新膀胱容量大、压力低、顺应性好，并发症少，是女性膀胱原位重建的良好术式。

Objective To evaluate the clinical application of female orthotopic ileal neobladder. Methods Modified radical cystectomy plus orthotopic ileal neobladder was performed on 19 female pa tients with bladd＆ cancer from June 1999 to January 2008. The mean age of the patients was 52（45--66） years, mean course of disease was 4.4 months （16 days 1.9 years）. Of all the patients, there were 10 cases with grade 1, 7 cases with grade 2 and 2 cases grade 3. According to the UICC stage system, 5 patients were T1 stage, 12 T2 and 2 T3a. All the patients received modified radical cystecto my without resection of uterus and anterior vagina, meanwhile the nerves around urethra were protec ted. 0.8--1.2 cm proximal end of the urethra was excised and 30 cm distal ileum was used for the re- construction of the neobladder, Results Sixteen cases were followed up for 6 102 months, mean 71 months. Fifteen patients survived without disease recurrence, 1 patient died of myocardial infarc tion 17 months postoperation. The daytime and night continent rate was 100%, 93% at 9 months postoperative. The average voiding volume of the 15 patients was 519.0 ml. The average residual volume was 29.2 ml, and Qmax was 18.6 ml/s. The average filling and voiding pressure was 16. 7 cm H2O and 53.0 cm H2O. Intravenous urography showed slight hydronephrosis in 1 case. Conclusion Female orthotopic ileal neohladder could be a good choice because of the continence, fewer complications, lower pressure and enough bladder capacity.