两种原位新膀胱术相关临床疗效及并发症的观察比较

Clinical efficacy of the two orthotopic neobladder and observation of the related complications of new-bladder

目的:评价原位回肠新膀胱(IN)和乙状结肠新膀胱(SN)术后的临床疗效,观察相关并发症。方法:65例膀胱癌患者,IN 40例,SN 25例。结果:65例患者平均随访18个月。术后6个月,IN组最大贮尿量较SN组多;膀胱充盈压及膀胱排尿压均较SN组低。IN组白天尿控满意率为87.5%,SN组为92.0%;SN组夜间尿控满意率为48.0%,IN组为65.0%,差异均无统计学意义。术后并发症:漏尿4例,排尿困难2例,术后感染2例,粘液堵塞2例,尿失禁1例,肠梗阻1例;勃起功能障碍6例,吻合口狭窄4例,慢性尿潴留3例,上尿路积水2例,盆腔转移1例。结论:回肠新膀胱可以达到足够的贮尿量和较好的尿流动力学改变,控尿满意。回肠是优先选择的新膀胱材料。

Objective： To evaluate clinical efficacy among patients who had gone orthotopic neobladder substitution with sigmoid or ileal segments,observe the related complications.Methods： 65 cases of bladder urothelial carcinoma,Forty patients with an ileal neobladder（IN） and 25 patients were received a sigmoid neobladder（SN）. Results：Complete follow-up was performed in 65 cases 18 months averagely postoperatively.The patients were examined after6 months. The average reservoir capacity of IN was higher than of SN, the bladder filling pressure and urination bladder pressure were lower than of SN. Daytime continence was 87.5% in IN group and 92.0% in SN group,nighttime continence was 65.0% in IN group and 48.0% in SN group. Complications including urine leakage in 4 cases,void dysfunctions in 2 cases, wound infectious in 2 cases, mucus jammed the urethra in 2 cases, urinary incontinence in 1 case, bowel obstruction in 1 case; ED in 6 cases, anastomosis stricture in 4 cases, chronic urinary retention in 3cases, hydronephrosis in 2 cases, pelvic metastases in 1 case.Conclusion： A neobladder constructed from detubularized ileum achieves adequate reservoir capacity,accepted urodynamics with a satisfactory continence rate.Ileum are ideal bladder substitutions.