根治性膀胱全切后改良MainzⅡ式膀胱术96例临床分析

Clinical effects of modified Mainz Ⅱ after radical cystectomy for 96 cases

目的：探讨根治性膀胱全切后改良MainzⅡ式膀胱术的术后临床效果。方法：采用改良MainzⅡ膀胱术治疗膀胱癌患者96例，通过监测肾功能和尿控情况，观察有无逆行感染及切口感染、肾积水、肠瘘等并发症，并做生活质量评分（QOL），从而判断手术疗效。结果：96例患者手术均获得成功，手术时间3～10h，平均6h；出血量200～1000ml，平均400ml。随访6～36个月，96例患者均无尿失禁；排尿次数1次／2～5h，平均1次／3h，每次尿量100～500ml，平均300ml；5例逆行感染，12例切口感染，9侧肾积水，其中3例双侧肾积水，25例轻度高氯性酸中毒，2例肠瘘，1例术前肾积水术后肾萎缩，肿瘤复发转移5例，4例死亡。QOL为0～5分，平均2．5分（介于满意和大致满意之间）。结论：改良MainzⅡ式膀胱术具有操作简单、手术时间短、复发率低、并发症少等优点，可作为一种可控性尿流改道的术式选择。

Objective.. To explore the clinical effects of modified MainzⅡ after radical cystectomy. Method： Ninety-six patients with bladder cancer performed modified Mainz Ⅱ after radical cystectomy were followed up. Renal function and urinary control of all patients were monitored. Complications such as retrograde infection, wound infection, hydronephrosis and intestinal fistula were observed and Quality of Life （QOL） score was used to judge the surgical effect. Result： All operations were successful. The postoperative data were as follows： operative time was 3-10 （mean, 6） hours; blood loss was 200-1000 （mean, 400） ml. No urine incontinence was found dur- ing the follow-up period of 6-36 months. Intercontraction interval was 2-5 （mean, 3） hours and each urine volume was 100-500 （mean, 300） ml. Five patients were found retrograde infection and 12 patients were diagnosed with wound infection and dehisce. Hydronephrosis was found in nine cases in which three patients were presented bila- tral hydronephrosis. Twenty-five patients suffered from mild high chlorine acidosis and two patients were discov- ered intestinal fistula. One patient of preoperative hydronephrosis developed nephrarctia postoperatively. Tumor metastasis and recurrence was detected in five cases and four patients died. QOL score was 0-5 （mean, 2.5）. Con- clusion..Modified Mainz Ⅱ prove to be an effective method for urinary diversion because of its easy operation, short operation time, low recurrence rate and few complication.