原位回肠新膀胱手术的临床研究

Clinical research of ileal orthotopic neobladder after radical cystectomy

目的:探讨全膀胱切除原位回肠代膀胱术治疗浸润性膀胱肿瘤的临床疗效及术后并发症的预防。方法:回顾性分析南京医科大学第一附属医院泌尿外科2005年1月～2008年3月21例膀胱肿瘤行全膀胱切除原位回肠代膀胱术的临床资料。结果:所有病人均得到满意随访,本组患者除2例外均无瘤存活。手术时间为5.5～7.5h,平均5.9h;术中出血量为150～1200ml,平均为450ml;所有患者术后均能自控排尿,无上尿路积水,代膀胱残余尿量20～80ml,功能状态良好。结论:全膀胱切除原位回肠代膀胱术具有术后代膀胱容量大、内压低、可控性能好等优点,是一种较理想膀胱全切术后的膀胱替代术式。

Objective：To investigate the therapeutic effect and post-operative complications of modified ileal orthotopic neobladder after radical cystectomy. Methods：Radical cystectomy and ileal neobladder were applied in 21 male patients with improved surgical method. Results：Twenty-one cases of ileal neobladders have been followed up for 1 to 4 years with a mean of 2.1 years. The operation was taken 5.5 to 7.5 hours with a mean of 5.9 hours. The intraoperative blood transfusion was 150 ml to 1 200 ml with a mean of 450 ml. All patients achieved excellent follow-up. The mean bladder capacity of the entire group was 330 ml,and residual urine volume was less than 80 ml. No patient suffered for electrolytical disturbance and urethral tumour recurrence. Conclusion：The modified radical cystectomy and ileal neobledder was a perfect surgery artifice.