原位新膀胱储尿囊不可控性收缩波观察及其临床意义分析

Observation and clinical analysis of the uncontrollable contraction of orthotopic neobladder

目的:通过尿动力学分析,观察原位回肠与乙状结肠新膀胱患者储尿囊中不可控性收缩波的发生情况及特点,探讨其与患者术后尿失禁发生的相关性。方法:对2008年1月~2017年8月期间于我院行膀胱全切原位新膀胱术的9例患者(男8例,女1例)进行尿动力学分析,重点关注储尿囊不可控性收缩波的特点及其临床意义。结果:所有患者均在行尿动力学分析时发现存在节律性不可控性收缩波,不可控性收缩波表现出固有性、节律性、易激性、收缩波幅呈容量相关性的特点,并与原位新膀胱术后尿失禁的发生密切相关。与回肠新膀胱相比,乙状结肠新膀胱具有有效容量较低、顺应性较低的特点,但残余尿更少,最大尿流率更高。结论:原位新膀胱储尿囊的不可控性收缩是制作储尿囊的肠管的固有运动特点,也是导致患者术后出现尿失禁的重要原因,需要临床医生予以关注并给予患者正确排尿指导。回肠新膀胱具有更佳的控尿能力,而乙状结肠新膀胱则具有更好的排空能力。

Objective: To observe the character of the uncontrollable contraction of orthotopic ileal neobladder and sigmoid neobladder through urodynamic analysis, and the relationship between uncontrollable contraction of neobladder and urinary incontinence. Method: Urodynamic analysis was performed in 9 patients(8 males and 1 female) who have accepted orthotopic neobladder in our department from January, 2008 to August, 2017. The rate, pressure, contributor of uncontrollable contraction of neobladder, and the relationship between uncontrollable contraction and urinary incontinence were observed. Result: The uncontrollable contraction with characters such as inherency, rhythmicity, sensibility could be found in all of the neobladder, and the pressure caused by the contraction was decided by the volume of instilling water. And the uncontrollable contraction was an important reason of urinary incontinence of neobladder. Compared with ileal neobladder, the sigmoid neobladder got a smaller effective volume, higher rate of contraction, and poor compliance, but a less residual urine and higher maximum flow rate could be also gotten by the sigmoid neobladder. Conclusion: The inherent uncontrollable contraction is an important reason of postoperative urinary incontinence of orthotopic neobladder, which should be paid attention to by the urologists and patients. The ileal neobladder can get a good ability of urinary continence, but the sigmoid is better at emptying of the neobladder.