改良原位回肠代膀胱术(附25例报告)

A modified technique of total cystectomy and ileal orthotopic neobladder(report of 25 cases)

目的 探讨改良膀胱全切原位回肠代膀胱术的疗效。 方法 对 2 4例膀胱癌及 1例腺性膀胱炎患者采用改良膀胱全切原位回肠代膀胱术。膀胱全切采用顺行逆行相结合的方法。截取末段回肠 ,排列成W形 ,褥式缝合制作贮尿袋。输尿管以乳头法种植。 结果 2 5例手术时间平均4h ,输血量平均 5 5 0ml,术后 2 4例随访 2～ 84个月 ,平均 2 4个月 ,2 3例白天可控排尿 ,14例夜间自控排尿。仅 2例术后发生输尿管积水 ,1例术前左肾积水者术后无变化。 2例肾功能异常。 2 3例行膀胱排尿造影均未发现输尿管返流。术后出现低血钾者 2例 ,余 2 2例血电解质均在正常范围。无肠膀胱或尿道肿瘤复发者。 结论 改良膀胱全切原位回肠代膀胱术手术时间短 ,操作简单 ,出血少 ,并发症少 ,术后无膀胱输尿管返流 ,电解质紊乱发生率低。

Objective To present a modified technique of total cystectomy and ileal neobladder. Methods Radical cystectomy and ileal neobladder were performed for 25 male patients. The dome, the upper part or the lateral walls and the base of the bladder were dissected antegradly. After cutting the ureters, the mobilization was then made retrogradly.For the construction of the reservior, the isolated 40 cm ileal segment was opened along its antimesenteric border and then arranged into a W shape. The wall of ileal pouch was created by side-to-side blanket suture of the incised ileum. The ureters were implanted at the two corners of W shape with antireflux nipple. Results 24 of 25 cases of ileal neobladder have been followed up for 2 to 84 months with a mean of 24 months.The operation took 150 to 310 minutes with a mean of 240 minutes. The intraoperative blood transfusion was 0 to 1200 ml.1 patient died of cancer metastasis. 23 patients have achieved excellent daytime continence,whereas only 14 had nighttime continence. The mean bladder capacity for the entire group was 310 ml. Renal functions of 2 patients were mildly abnormal.Hypokalemia occurred in 2.There was no metabolic acidosis.There were 3 cases of hydroureter or hydronephrosis on one side. 1 calculus of neobladder was discovered on BUS. On voiding cystography, no reflux has been noted in all.And no patient suffered from urethral recurrence. Conclusions The modified total cystectomy and ileal neobladder takes less time and is more feasible.