全膀胱切除137例临床分析

A report on cystectomy in 137 cases

目的总结探讨全膀胱切除尿流改道不同术式的临床特点。方法回顾性分析137例行全膀胱切除术患者的临床资料,其中男117例,女20例;年龄36～88岁,平均65.2岁。经腹腔镜手术101例,其中9例术中改开放手术;传统开放术式36例。尿流改道方式:原位回肠新膀胱术86例,占62.8%;原位乙状结肠新膀胱术12例,占8.8%;回肠膀胱术20例,占14.6%;输尿管乙状结肠吻合术9例,占6.6%;输尿管皮肤造口术8例,占5.8%;胃代膀胱术2例,占1.5%。结果所有手术均获成功,手术时间为4～8h,术中出血400～1 600mL,随访3～60个月,术后早期并发症包括伤口感染、漏尿和肠梗阻等,严重并发症为肠瘘3例。围手术期死亡3例,死亡原因为呼吸、循环系统疾病。术后晚期主要并发症有泌尿系结石、尿路感染等。获随访的原位新膀胱术者51例,白天控尿良好48例(94.1%),夜间控尿良好43例(84.3%)。获随访的72例中男性67例,其中41例自诉阴茎可勃起,占61.2%(41/67)。术后无长期尿失禁,未发现尿道肿瘤。结论根治性全膀胱切除手术风险较高,术前应充分评估适应证;原位膀胱术是尿流改道的首选术式;全膀胱切除尿流改道严重并发症少,不易复发,患者生活质量高,是治疗浸润性膀胱癌的理想方法。

Objective To summarize 137 cases of radical cystectomy cases from 2006 to 2011 in our department.Methods The clinical data were retrospectively analysed on 137 cases of radical cystectomy.In this group,117 male patient,20 female.Age：36 to 88 years,average 65.2 years old.101 cases by laparoscopic surgery（9 patients were changed to open surgery）,36 cases by traditional open surgical procedures.Urinary diversion method：The most commonly used method was orthotopic ileal neobladder,86 cases（62.8%）,orthotopic sigmoid neobladder in 12 cases（8.8%）;ileal neobladder in 20 cases（14.6%）,ureter sigmoid anastomosis in 9 cases（6.6%）,ureter skin ostomy in 8 cases（5.8%）,gastric neobladder in 2 cases（1.5%）.Results All operations were successful,the operative time was 4-8 hours,blood loss was 400-1 600 mL,The follow-up was 3-60 months.early complications were wound infection,urine leakage and intestinal obstruction,serious complications was intestinal fistula in 3 cases.perioperative death occurred in 3 cases because of respiratory and circulatory system diseases.Late main postoperative complications were urinary tract stones,urinary tract infections.In 51 follow-up cases of orthotopic neobladder,48 patients（94.1%）were continent at daytime and 43（84.3%）were continent nocturnally,In the 67 male cases followed-up,penile erection occurred in 41 cases.There was no long-term incontinence,Urethra tumors was not found.Conclusion The risk of radical cystectomy is higher,preoperative indications should be fully assessed;orthotopic neobladder is the first choice of urinary diversion;Cystectomy urinary diversion is an ideal way for treating invasive bladder cancer beacause of fewer serious complications,less recurrence and high quality of life.