原位螺旋构型回肠新膀胱尿动力学分析

Urodynamics of orthotopic spiral ileal neobladder following radical cystectomy

目的 探讨并评价原位螺旋构型回肠新膀胱的尿动力学特点,以期为该术式的施行提供动力学依据.方法 选取施行原位螺旋构型回肠新膀胱术的20例男性患者,术后6、12个月进行尿流动力学检测,就尿流率、初始尿意膀胱容量、正常尿意膀胱容量、最大膀胱压容量、充盈压、最大排尿压及顺应性等进行测定、比较和分析.结果 术后所有患者均自主排尿,无需再次导尿,拔除导尿管1周后尿量为110～570（188.4±24.8）ml.其中19例（95.0%）白天控尿良好,17例（85.0%）夜间控尿良好.术后6、12个月复查静脉肾盂造影示新膀胱位置、形态良好,肾、输尿管未见明显扩张.患者术后12个月时初始尿意膀胱容量、正常尿意膀胱容量、最大尿意膀胱容量及残余尿量均明显增加（均P〈0.05）,其它参数间差异并无统计学意义（P〉0.05）.患者术后6个月和12个月最大尿道压、最大尿道闭合压及功能性尿道长度上均无明显差异（P〉0.05）.结论 原位螺旋构型回肠新膀胱具有容量大、相对低压、顺应性好和术后排尿、控尿功能更接近生理特征等特点,螺旋构型回肠新膀胱术是一种较为合理的原位膀胱替代方法.

Objective To evaluate the urodynamics of orthotopic spiral ileal neobladder after radical cystectomy for bladder carcinoma. Methods Twenty male patients with bladder carcinoma underwent radical cystectomy and received orthotopic spiral ileal substitution. The uroflow rate, neobladder capacity at first desire/normal, desire/urgency,cystometry, peak voiding pressure were determined 6 and 12 months after surgery, respectively. Results Neobladder capacity at first desire, normal desire and urgency 12 months after surgery were larger than those 6 months after surgery [（322.4±66.3 vs 302.4±51.9, 411.8±78.6 vs 381.5±43.7 and 520.2±72.9 vs 483.1±66.1）ml, all P〈0.05）], however, no significant differences were found in the vesical pressure at first desire, normal desire and urgency [（10.4±2.9 vs 10.6±3.1,12.1±3.1 vs 13.6±3.8 and 20.6±4.2 vs 21.1±4.6 ）cm H2O1 all P〉0.05]. There were no significant differences in maximum flow rate （Qmax） and peak voiding pressure [（ 16.7±4.3 vs 15.9±5.4） ml/s and （78.6±13.9 vs 82.7±11.8 ）cm H2O1 both P〉0.05） between two groups, but the volume of residual urine 12 months after surgery was larger than that 6 months after surgery [（72.6±34.7 vs 55.2±38.3 ）ml, P〈0.05].There were no significant differences in maximum urethral pressure（MUP）,maximum urethral closure pressure （MUCP） and functional urethral length （FUL}between two groups. Conclusion The urodynamic results support orthotopic spiral ileal neobladder as an effective treatment option after radical cystectomy for muscle-invasive bladder cancer.