球形可控性回肠代膀胱术(附26例报告)

In situ continent globular ileal neobladder(report of 26 cases)

目的 探讨球形可控性回肠贮尿袋代膀胱术的临床疗效。 方法 对 2 6例膀胱移行细胞癌患者采用末段回肠制成球形贮尿袋代膀胱的原位膀胱重建术。 结果 2 6例手术顺利 ,术后随访 3～ 36个月 ,平均 2 1个月。全组无严重并发症 ,健康存活 2 5例 ,1例术后 17个月死于脑溢血。排尿可控率 10 0 %。术后 12个月 2 0例平均尿量 5 85ml/次 ,剩余尿量 2 2ml,最大尿流率 17.3ml/s。膀胱测压 18例 ,平均半充盈、充盈和排尿压力分别为 12、17和 5 3cmH2 O(1cmH2 O =0 .0 98kPa)。病理切片示新膀胱粘膜变薄 ,粘膜腺体减少 ,绒毛消失 ,部分区域固有膜腺体消失 ,呈鳞状化生结构。PAS染色阳性、热休克蛋白 (HSP)阳性 ,p5 3基因表达阴性。 结论 球形可控性回肠贮尿袋代膀胱术具有容量大、压力低、可控性好 ,对机体干扰轻、并发症少等优点 ,是原位膀胱重建的良好术式。

Objective To evaluate the in situ continent globular ileal neobladder. Methods The neobladder was constructed with an isolated segment of 30 cm of distal ileum longitudinally opened.The ureters were antirefluxedly anastomosed to the constructed reservoir,the lower pole of which was anastomosed to the remnant urethra.The procedure has been carried out in 26 cases of bladder cancer after total cystectomy. Results All the cases have been followed up for 3～36 months with a mean of 21 months.1 patient died of apoplexy and the other 25 have been surviving well.The average voiding urine volume examined 12 months after operation was 585 ml.The average halffilling,filling and voiding pressures were 12 cm H 2O,17 cm H 2O and 53 cm H 2O respectively.Urine routine examination was normal with negative urine culture.Renal function and blood biochemistry have been normal.There has been no hydronephrosis or hydroureter.Pathological studies revealed thinning of the neobladder mucosa,decrease of adenoid structure,devoid of villi and some area becomes squamous.PAS and HSP were positive whereas p53 was negative. Conclusions Continent globular ileal urine reservoir in situ has the advantages of a large capacity,low intrareservoir pressure,good continence,little harm to the host and acceptable to the patient.