膀胱扩大术治疗结核性挛缩膀胱25例分析

Augmentation cystoplasty for tuberculous contracted bladder:a review of 25 cases

目的评价膀胱扩大术治疗结核性挛缩膀胱的效果。方法回顾性分析2009年1月-2020年9月解放军总医院第八医学中心泌尿外科结核性挛缩膀胱行开放性乙状结肠膀胱扩大术22例、回肠膀胱扩大术3例患者的临床资料。记录手术时长、术中出血量、抗痨时长、术后住院时长、术后12月的日间排尿间隔及最大膀胱容量、膀胱残余尿量、末次随访血清肌酐及不良事件。结果男性12例,女性13例,年龄(35.6±11.5)岁。术前8例血清肌酐升高,16例经皮肾造瘘术,21例单侧肾切除史,最大膀胱容量(52±15)mL,日间排尿间隔(26±16)min。手术时长(278±62)min,术中出血(320±154)mL,术后住院时长(21±13)d,未见肠瘘、尿瘘、活动性出血早期不良事件发生。术后12月最大膀胱容量(305±76)mL,残余尿量(48±13)mL,日间排尿间隔(138±18)min,20例(80%)日间排尿间隔>2 h,较术前差异有统计学意义。22例(88%)末次随访血清肌酐正常,13例(52%)反复尿路感染,2例发生泌尿系结石,1例术后8年死于肺癌。结论膀胱扩大术治疗结核性膀胱挛缩可有效增加膀胱容量,保护肾功能,安全性好。

Objective To evaluate the efficacy of augmentation cystoplasty in the treatment of tuberculous contracted bladder.Methods Clinical data of 25 patients with tuberculous contracted bladder who underwent sigmoidocystoplasty(n=22)or ileocystoplasty(n=3)during Apr.2009 and Sep.2020 were respectively analyzed.The operation time,volume of blood loss,duration of anti-tubercular therapy,hospital stay,micturition diurnal frequency 12 months after surgery,maximum capacity of neobladder,residual urine volume,serum creatinine at the end of follow-up and complications were recorded.Results There were 12 males and 13 females,with an average age of(35.6±11.5)years.Before bladder enlargement,8 patients had increased serum creatinine,16 underwent percutaneous nephrostomy and 21 had a history of unilateral nephrectomy.The maximal bladder capacity was(52±15)mL and the micturition diurnal frequency was(26±16)min.The operation time was(278±62)min and the volume of blood loss was(320±154)mL,with a mean hospital stay of(21±13)day.No early postoperative complications such as colonic fistula,urinary fistula,adhesive obstruction or active bleeding were observed.Twelve months after surgery,the maximal capacity of neobladder was(305±76)mL,the residual urine volume was(48±13)mL,the micturition diurnal frequency was(138±18)min,and 20 patients had diurnal frequency≥2 h.These postoperative indexes had significant differences compared with the preoperative baseline.At the last follow-up,22 patients had normal serum creatinine,13 had recurrent urinary infection,2 had renal calculi and 1 died from lung cancer 8 years after sigmoidocystoplasty.Conclusion Bladder augmentation for patients with tuberculous contracted bladder is safe and effective to restore automatic micturition and preserve renal function.