改良式烟筒形回肠输尿管吻合法在原位新膀胱中的临床研究

Clinical Studies of Modified Chimney Method of Uretero-Ileal Anastomosis in the Orthotopic Neobladder

目的:探讨改良式烟筒形回肠输尿管末端吻合法在可控W形回肠新膀胱术中的应用和疗效。方法:对62例膀胱全切除术后可控W形回肠新膀胱术的患者,实施了改良式烟筒形回肠与输尿管末端吻合。其中12例肠系膜过短者进一步游离肛门侧的回肠,未去管化直接拉进盆腔与尿道吻合。结果:本组手术时间平均为300min,术中出血量平均为500 mL;术后随访24个月,平均16个月,失访19例,死亡8例。术后1年膀胱容量平均为500 mL,残余尿量平均为0～50 mL;术后1个月内,发生肾积水8例14个肾(11.3%),但3个月后全部消失、短暂性新膀漏尿6例(9.7%)、急性肾盂肾炎4例(6.5%)、尿道狭窄5例(8.1%),经对症治疗好转。结论:改良式烟筒形回肠与输尿管末端吻合法及未去管化的肛门侧回肠与尿道吻合法,手术时间短,出血和并发症少,控尿效果好,尤其在肠系膜过短者效果良好,值得推广。

objective： To investigate the application and efficacy of the modified chimney method of uretero-ileal anastomosis in the continent W-shape ileal neobladder. Methods： The modified chimney method of uretero-ileal anastomosis was conducted in 62 patients with invasive bladder cancer after radical cystectomy and bladder substitution by continent W-shape ileal neobladder. In 12 pa- tients, the distal end of the ileal loop was first released and brought to the pelvic fossa without detubularization because of the short ileal mesentery. Results： In the current investigation, the average operation time was 300 min and mean blood loss during operation was 988 ml. After surgery, the patients were followed up from 12 to 24 months （ average 16 months ）. Nineteen patients did not return for follow up and eight died. After one year, the average bladder capacity was 500 mE and the residual volume was 0 - 50 mE. Complications after surgery included 8 cases of hydronephrosis （ 11, 7% ） that resolved after 3 months, 6 cases of transient urine fistula of the neobladder （ 9.7% ）, 4 cases of acute pyelonephritis （ 6.5% ）, and 5 cases of urethral stricture （ 8.1% ）. Conclusion： The advantages of the modified chimney method include short surgical duration, fewer complications, less blood loss, and excellent continence.