乙状结肠新膀胱术治疗肌层浸润性膀胱癌15例疗效观察

The curative effect observation of sigmoid neobladder in 15 cases with invasive bladder cancer

目的:观察根治性膀胱切除术后乙状结肠新膀胱术治疗肌层浸润性膀胱癌的效果。方法:对15例肌层浸润性膀胱癌的男性患者先行膀胱全切术,然后采用乙状结肠新膀胱术,对其疗效及技术要点进行分析。结果:术后15例获随访6～72个月。5例出现双侧轻度肾积水,1例单侧肾积水;新膀胱容量达210～456 ml,膀胱静压为18.6～31.8 cm H2O,排尿时膀胱内压为36.21～71.56 cmH2O,最大尿流率10.22～12.26 ml/s,残余尿量33～58 ml。1例在第1年内出现暂时性白天尿失禁,11例有不同程度夜间尿失禁。结论:乙状结肠新膀胱术贮尿容积大,原位自主排尿,白天控尿效果较好,夜间控尿情况较差。肾功能保护较好,无明显的水、电解质及酸碱平衡紊乱,是较理想的原位膀胱替代术。

Objective：To investigate the curative effect of sigmoid neobladder after radical cystectomy in 15 patients with invasive bladder cancer.Methods：Sigmoid neobladder was conducted after radical cystectomy in 15 males with bladder cancer.The curative effect and technical points were analyzed.Results：Fifteen cases were followed up for 6 to 72 months.Bilateral and unilateral hydronephrosis was found in 5 cases and in 1 case,respectively.The volume of urodochium was 210 to 456 ml,and the static pressure in neobladder was 18.6 to 31.8 cmH2O.Vesical micturition pressure was 36.21 to 71.56 cmH2O.Qmax was between 10.22 to 12.26 ml/s.The residual urine volume was 33 to 58 ml.Daytime incontinence was found in 1 case in the first year after operation.Nocturnal urinary incontinence was found in 11 cases.Conclusions：The sigmoid neobladder had several advantages including an adequate reservoir capacity,recovery of automatic micturition,good renal function,no acid-base and electrolyte imbalance,and the continence effect was good at daytime,but not good at night.It could be a good choice a better operation in replacing bladder.