正位回肠膀胱重建术(附26例报告)

Orthotopic ileal neobladder reconstruction after radical cystectomy (Report of 26 cases)

目的:探讨膀胱全切术后理想的膀胱替代术式。方法:采用回肠折叠成“W”形或“U”形贮尿囊与尿道吻合,尿液经原尿道排出的正位回肠膀胱重建术治疗膀胱全切术患者26例。结果:围术期无一例死亡,随访0.5～2.5年,膀胱容量220～460 ml,平均380 ml;膀胱充盈压1.27～4.41 kPa(平均2.94 kPa);最大尿流率1 2～20 ml/s(平均18 ml/s);新膀胱排尿功能良好;3例出现上尿路积水,间断自我导尿后好转;血电解质显示7例患者血清Cl-偏高,但无酸中毒发生,血清肌酐、尿素氮均在正常范围。结论:正位回肠膀胱重建术是较理想的膀胱替代术式。

Purpose:To improve the surgical technique in the reconstruction of a neobladder after radical cys-tectomy. Method;The neobladder which was constructed with W-shaped or U-shaped ileal urodochium was anastomosed to the urethra in 26 patients and all voided through the primary urethra. Result:There was no perioperative death. The patients were followed-up for 6 months to 2. 5 years after the operations. The capacity of the neobldder was 220 - 460 ml with a mean of 380 ml and maximal intrareservoir pressure during filling was 1. 27 ~4. 41 kPa with a mean of 2. 94 kPa. All patients obtained good daytime urinary control and none required protective pads, although three patients used protective pads at night because of nocturnal leakage. Intermittent self-catheterization was necessary in 3 cases to obtain adequate emptying of the neobladder because of hydronephrosis. Conclusion: Or-thotopic neobladder reconstruction was an ideal operation after total cystectorny.