保留性功能全膀胱切除回肠原位新膀胱术对膀胱癌患者的影响

The effect of sexual function preserved total cystectomy and ileal neobladder on patients with carcinoma of urinary bladder

目的阐述保留性功能全膀胱切除术＋回肠原位新膀胱术对膀胱癌患者术后控尿、性能力及肿瘤控制效果的影响。方法收集2010年1月至2016年1月膀胱移行细胞癌患者26例，男性，平均年龄（55．3±2．3）岁。应患者对控尿和性功能的需求，施行保留性功能全膀胱切除术＋回肠原位新膀胱术，术中对输精管及精囊、两侧神经血管束、大部分前列腺包膜进行保留，随访观察术后疗效及生活质量。结果术后病理分期T2aN0M018例、T2bN0M08例，平均随访3～72个月，有低分化膀胱尿路上皮癌死亡2例，因术后半年后发生远处转移死亡。平均手术时间5．5h；平均出血500ml；所有患者的勃起及逆行射精功能均得到保存，除死亡病例肿瘤未进行性发展或转移，IIEF-5平均22分；患者的控尿率昼间达100％，夜间尿失禁2／24；新膀胱储尿容量400～520ml，充盈压14～25cmH2O（1cmH2O=0．098kPa）；残余尿10-25ml。结论对强烈要求的膀胱尿路上皮癌患者，进行严格删选后采用保留性功能的全膀胱切除回肠原位新膀胱术，可以更好地保留勃起、射精，改善患者控尿功能，提高了患者生活质量和社会形象，并可-定程度上控制肿瘤。

Objective To observe the effect of sexual function preserved radical cystectomy and ileal neobladder on postoperative urine control, sexual function, and tumor control of patients with carcinoma of urinary bladder. Methods 26 patients with bladder transitional cell carcinoma admitted to our hospital from January 2010 to January 2016 were collected, who were male with the average age of （55.3~2.3） years old. In response to patients＇ requirements of urine control and sexual function, sexual function preserved radical cystectomy and ileal neobladder were carried out to preserve seminiferous duct, seminal vesicle, bilateral neurovascular bundle, and most prostatic capsule during the operation. Observed postoperative efficacy and life quality during follow-up. Results There were 18 cases of postoperative pathological staging T2aNOM0 and 8 cases of T2bNOM0, with follow-up of 3 to 72 months. There were 2 dead cases of poorly differentiated bladder urothelial carcinoma caused by distant metastasis half a year after the operation. The average operation time was 5.5 h, and the average bleeding was 500 ml; erectile and retrograde ejaculation function of all patients were preserved. There was no progressive course or transfer of tumor except for death case. The average IIEF-5 score was 22. The daytime urine control rate in the patients was up to 100%, and the nighttime urinary incontinence rate was 2/24; the urine storage capacity of new bladder was 400 to 520 ml, and the filling pressure was 14 to 25 crnH2O（1 cmH2O = 0.098 kPa）; the residual urine volume was 10 to 25 ml. Conclusions After strict selection for patients with bladder urothelial carcinoma, sexual function preserved radical cystectomy and ileal neobladder can better maintain the erection and ejaculation function, improve patients＇ urine control function, improve patients＇ life quality and the social image, and can control the tumor to a certain extent. [ Key words ]