原位回肠膀胱对上尿路功能影响的回顾性分析

Orthotopic ileal neobladder for upper urinary tract function

目的:探讨原位回肠膀胱对上尿路功能的影响。方法:评估2006年3月至2011年6月陕西省核工业二一五医院泌尿外科收治的34例肌层浸润性膀胱尿路上皮癌行膀胱全切W形原位回肠代膀胱患者的上尿路功能,所有病例随访时间5年以上,均无复发及转移。评估项目包括肌酐测定、泌尿系B超测定膀胱残余尿量及肾积水量、膀胱造影明确有无尿液返流。结果:术后2年,膀胱造影5例(14.7%)患者出现反流致轻度肾积水,与术前比较差异无统计学意义(χ~2=2.110,P>0.05),术后5年,膀胱造影6例(17.6%)患者出现反流致轻度肾积水,与术前比较差异无统计学意义(χ~2=1.531,P>0.05);术前血肌酐(77.32±13.78)mmol/L,术后2年血肌酐(78.50±12.37)mmol/L(t=-1.93,P>0.05);术后5年血肌酐(82.15±22.49)mmol/L(t=-2.36,P>0.05),无统计学差异,且均在正常范围。术后2年膀胱容量(413±19)ml,残余尿量(57.3±36.1)ml,术后5年膀胱容量(423±17)ml,残余尿量(53.3±33.7)ml,残余尿量差异无统计学意义(t=-0.29,P>0.05)。结论:原位W型回肠膀胱可作为膀胱全切术后理想的代膀胱术式,对上尿路功能影响较轻。

Objective： To explore the impact of orthotopic ileal neobladder for upper urinary function. Methods：Assess 34 patients with muscle invasive bladder urothelial carcinoma cystectomy W-shaped orthotopic ileal neobladder patients with upper urinary tract function in Department of Urology,the Nuclear Industry 215 Hospital of Shaanxi Province（ Mar. 2006 to Jun. 2011）. All patients were followed for over 5 years. Assessment projects including creatinine determination,urinary B-determination of the amount of residual urine volume hydronephrotic cystography clear whether urinary reflux. Results： 2 years after the operations,5 cases（ 14. 7%） with mild hydronephrosis caused by reflux were found in the study,the difference was not statistically significant（ χ2= 2. 110,P〈0. 05）. 5 years after the operations,6 cases（ 17. 6%） with mild hydronephrosis caused by reflux were found in the study,the difference was not statistically significant（ χ~2= 1. 531,P〈0. 05）. The serum creatinine of preoperation was（ 77. 32 ± 13. 78）mmol/L,The serum creatinine of 2 years and 5 years after the operations was（ 78. 50 ± 12. 37） mmol/L and（ 82. 15± 22. 49） mmol/L,the difference was not statistically significant. Preoperative and postoperative serum creatinine mean were in the normal range. The bladder volume was（ 413 ± 19） ml,and the residual urine volume was（ 57. 3 ±36. 1） ml at the 2 years after surgery. The bladder volume was（ 423 ± 17） ml,and the residual urine volume was（ 53. 3 ± 33. 7） ml at the 5 years after surgery,the difference of the residual urine volume was not statistically significant（ P〈0. 05）. Conclusion： Orthotopic ileal neobladder in W can be used as the ideal bladder operation after total cystectomy,and it has little effect on upper urinary tract function.