女性原位新膀胱重建术中远期疗效观察

Mid-long-term follow-up of radical cystectomy with orthotopic ileal neobladder in women patients with bladder carcinoma

目的 评价女性膀胱全切原位尿流改道的中远期疗效.方法 回顾性分析2003年2月至2012年8月28例女性膀胱全切原位尿流改道患者的临床资料.所有患者均行膀胱全切加原位回肠新膀胱术,其中6例一并切除子宫.开放手术19例,腹腔镜手术9例.新膀胱重建采用T型回肠膀胱17例,改良Studer回肠膀胱11例.结果 28例均获随访,随访时间8～ 114个月,平均55个月.患者均能自行排尿,术后6、12和24个月,日间完全控尿率分别为82.1％、92.3％和90.5％;夜间完全控尿率分别为53.6％、88.5％和90.5％.术后6、12、24个月平均贮尿囊容量分别为（282±87） ml、（345±72） ml和（357 ±75）ml,充盈期平均贮尿囊压力分别为（10.8±3.2） cmH2O（1 cmH2O =0.098 kPa）、（6.7±2.6） cmH2O和（6.2 ±2.1）cmH2O.膀胱阴道漏1例,手术修补治愈.尿道吻合口狭窄1例,经规律尿道扩张6个月治愈.血清电解质正常,肾功能稳定.无肿瘤复发及转移.结论 女性膀胱癌患者原位尿流改道术远期疗效满意,是一种理想的尿流改道术式.

Objective To assess the mid-long-term efficacies of orthotopic urinary diversion in women.Methods From February 2003 to August 2012,28 female patients with bladder cancer underwent radical cystectomy and orthotopic ileal neobladder.Open （n =18） and laparoscopic （n =9） procedures were performed.Ileal neobladder included 17 T-pouch and 11 modified Studer pouch reconstruction.The continence status,urodynamics,serum electrolyte and renal function were followed up.Results The mean follow-up period was 55 （8-114） months.Excellent continence was achieved during day-time in 82.1%,92.3% and 90.5% cases at 6,12 and 24 months postoperatively and in 53.6%,88.5% and 90.5% cases at night respectively.The mean capacity of pouch was 282 ± 87,345 ± 72 and 357 ± 75 ml at 6,12 and 24 months postoperatively respectively.The mean filling pressure of pouch was 10.8 ± 3.2,6.7 ± 2.6 and 6.2 ±2.1 cmH2O postoperatively respectively.One case of neobladder-vaginal fistula was cured by surgical repair.Another case of urethral stenosis responded well after regular dilation for 6 months.Renal function and electrolyte metabolism were stable in all cases.There was no instance of tumor recurrence or metastasis.Conclusion Orthotopic urinary diversion in females has excellent long-term results with fewer complications so that it is highly recommended.