回肠新膀胱术的临床疗效观察

A follow up study of ileal neobladder

为客观地评价回肠新膀胱术的远期疗效，对５２例术后病人的可控性、尿动力学、肾功能、贮尿囊组织学变化及尿ｓＩｇＡ等进行随访研究。４９例获随访３～６６个月，平均随访３５个月。日间可控率为９４％，夜间为８１％。平均最大膀胱容积为４２４．５ｍｌ，最大内压为２．７０ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），平均剩余尿２４．８ｍｌ，最大尿流率为１８．０ｍｌ／ｓ。ＩＶＵ示８例１１条输尿管轻中度扩张，膀胱造影２例轻度返流，血肌酐、尿素氮保持正常，尿ＮＡＧ２例升高。术后病人尿ｓＩｇＡ较高。随术后时间延长，贮尿囊绒毛及微绒毛逐渐萎缩，酸中毒发生率下降，尿内粘液减少。肿瘤尿道复发１例。认为回肠新膀胱术是一种可选择的手术。

of 52 cases of ileal neobladder have been followed up for a mean of 35 months.Day continence has been achieved in 94% and night time continence in 81%.The mean maximum bladder capacity has been 424.5ml and the mean intravesical pressure 27.5cmH 2O.The mean maximum flow rate has been 18.0ml and the residual urine 24.8ml.On IVU 11 ureters in 8 patients (15%) revealed slight or medium dilatation and 2 patients (4%) revealed mild reflux on cystourethrography.Urinary NAG was elevated in 2 cases (4%).Higher level of urinary sIgA was observed in all the patients.As time went by,hyperchloremic acidosis became less because of the atrophy of the ileal villi and microvilli.Tumor recurrence has been detected in one patient (2%).It was concluded that ileal neobladder is feasible for clinical application.