腹腔镜根治性膀胱切除行全去带乙状结肠原位新膀胱术后早期控尿功能观察

Observation of urinary continence of neobladder using complete detenial sigmoid colon after radical cystectomy in a short period

目的:评价腹腔镜根治性膀胱切除后行全去带乙状结肠原位新膀胱术后早期控尿功能的恢复。方法:回顾性分析2010年6月～2017年6月我院行腹腔镜根治性膀胱切除术后采用全去带乙状结肠原位新膀胱术患者的临床资料,并对术后患者尿流率、储尿囊排空尿量及自控性排尿、尿意进行分析研究。结果:本组共47例,男46例,女1例,其中45例术后定期随访。术后3个月,日间自控排尿的患者37例(控尿2级、3级分别为22例和15例),夜间自控排尿27例;患者最大尿流率为5.0～24.0ml/s,平均(13.4±4.4)ml/s;储尿囊排空尿量90.0～250.3ml,平均(135.5±42.2)ml;残余尿为(20.09±11.7)ml。术后6个月,日间自控排尿42例(控尿2级、3级分别为12例和30例),夜间自控排尿30例;随访患者最大尿流率为5.5～28.0ml/s,平均(14.4±4.8)ml/s;储尿囊排空尿量93.2～287.2ml,平均(149.0±46.1)ml;残余尿为(14.52±6.5)ml。结论:腹腔镜根治性膀胱切除术后全去带乙状结肠原位新膀胱术在术后早期尿控达到较满意水平,是一种可行的术式。

Objective：To evaluate the urinary continence of neobladder using complete detenial sigmoid colon after radical cystectomy in the early postoperative period.Method：The patients who had undergone the orthotopic sigmoid neobladder after radical cystectomy between June 2010 and June 2017 were retrospectively analyzed.The analysis covered the rate of voiding,volume of neobladder,continence of voiding and micturition desire.Result：Of all the 47 patients that included 46 males and 1 female,45 patients were followed up regularly and 1 patient whose postoperative period did not reach 6 months.Three months after the surgery,37 patients maintained daytime continence（Level 2 and Level 3 of urinary continence were 22 and 15 cases,respectively）,and 27 patients maintained nighttime continence.What＇s more,the maximal flow rate（within 3 months after the surgery）of the follow-up patients was from 5.0 ml to 24.0 ml,and the mean maximal flow rate was（13.4 ±4.4）ml/s.The capacity of neobladder was from 90.0 ml to 250.3 ml,and the mean volume was（135.5±42.2）ml.The mean residual urine was（20.09±11.7）ml.Six months after the operation,42 patients maintained daytime continence（Level 2 and Level 3 of urinary continence were 12 and 30 cases,respectively）,and 30 patients maintained nighttime continence.Moreover,the maximal flow rate（within 6 months after the surgery）of the follow-up patients was from 5.5 ml to 28.0 ml,and the mean maximal flow rate was（14.4±4.8）ml/s.The capacity of neobladder was from 93.2 ml to 287.2 ml,and the mean volume was（149.0±46.1）ml.The mean residual urine was（14.52±6.5）ml.Conclusion：Orthotopic sigmoid neobladder can achieve satisfactory continence of urine in the near future,which is highly recommended.