女性全膀胱切除原位回肠新膀胱术20例报告

Summarization of female total cystectomy ileal orthotopic neo-bladder replacement (report of 20 cases)

目的探讨女性全膀胱切除原位回肠新膀胱术的技术改进及临床应用价值。方法 2004年1月至2009年1月,对20例女性膀胱肿瘤患者行全膀胱切除原位回肠新膀胱术,其间进行了系列改良探索,包括保留子宫、卵巢及附件的膀胱全切;保留完整尿道、阴道及自主神经的膀胱全切;腹膜外顺行切除膀胱;手助拔针邻边全层连续褥式缝合制作"W"回肠新膀胱;用直线切割吻合器恢复肠道连续性;用自制引导探子引导新膀胱与尿道吻合等。随访观察肿瘤控制、并发症及排尿控尿功能。结果手术时间平均330min,术中平均出血560ml。术后2～4周拔除尿管,患者排尿通畅。18例获得随访,平均随访时间38个月,术后12个月内恢复昼夜尿控分别为94.4%和88.9%,新膀胱容量平均330ml,蹲式手辅腹压排尿下,最大尿流率平均24.6ml/s,残余尿量0～25ml。无肿瘤复发及种植转移。结论经初步观察,女性膀胱肿瘤患者行膀胱全切,可尝试保留子宫、卵巢、附件和完整的尿道、阴道;全膀胱切除原位回肠新膀胱术较适于女性患者;所行系列改良可降低手术难度,减少并发症,在肿瘤根治的同时利于控尿恢复。

Objective To evaluate technique innovation and its clinical value in female total cystectomy ileal orthotopic neo-bladder replacement.Methods 20 cases female patients with bladder tumour had been undergone total cystectomy ileal orthotopic neo-bladder replacement during January of 2004 to January of 2009,in which a series of modifications and explorations were performed including reserving uterus,ovary,appendages;complete urethra,complete vagina and autonomy nerve in cystectomy;direct extraperitoneal resection of bladder;＂W＂ type ileal neo-bladder made by single layer continuous mattres-suture along the edges and manual assistant needle removal,ileal anastomosis using straight Cutter Stapler,neo-bladder-urethral anastomosis through application of handmade metal urethral probe with tip guiding hole.Tumor control,operation complication and fuction of micturition and continence were followed up.Results The average operatng time was 330 min.The average blood loss was 560 ml.Micturition was fluent after urethral catheters was removed in 2-4 weeks after operation.In 18 cases with follow-up of average 38 months,the ratio of functional recovery of daytime urinary continence within 1 year was 94.4%,nighttime was 88.9% respectively.The average volume of neo-bladder was 330 ml.The average Qmax was 24.6 ml/s,and residual urine volume was 0-25 ml under the situation of manual assistant abdominal pressure squatting micturition.Carcinoma plant metastasis and recurrence were not found.Conclusions It is observed that uterus,ovary,appendages,complete urethra and vagina can be reserved in total cystectomy for female patients with bladder tumour,total,cystectomy ileal orthotopic neo-bladder replacement is beneficial to female patients,a series of modifications can reduce surgical difficulty and operation complication,are beneficial for recovery of urinary continence and consequently achieve radical resection of tumor at the same time.