球形可控回肠原位膀胱术38例

Globular content ortholopic ileal neobladder

目的 研制贮存和排出尿液功能近似正常膀胱的原位膀胱重建新术式。方法 用末段回肠30 cm,乙醇浸泡肠粘膜,N形排列去管后制成球形贮尿囊。输尿管与贮尿囊行抗返流吻合,贮尿囊下端与尿道断端吻合。临床应用38例。结果获得随访38例,随访时间3-42(平均32)月。37例健在。排尿可控率100％。术后12月20例平均尿量585.6 mL/次。残余尿22 mL。Qmax17.3ml·s-1。膀胱测压18例,平均半充盈、充盈和排尿压力分别为1.18、1.62、4.60kPa。尿常规正常,尿培养(-);肾功能及血生化正常。无肾、输尿管积水。病理示新膀胱粘膜变薄,粘膜腺体减少,绒毛消失,部分区域固有膜腺体消失,呈鳞状化生结构。PAS、HSP阳性,p53阴性。结论 球形可控回肠原位膀胱术具有容量大、压力低、可控性好,对机体干扰轻,并发症少,易接受等优点。

AIM To investigate the globular content ortholopic ileal neobladder of approximte nomal function. METHODS An isolated intestinal segment of 30cm distal ileum was formed as a globular reservior after being opened longitudinally .The distal ureter of both anti-reflex anastomoset to the reservoir.The most low epartment of reservoir was anastomset to the ureth .This method was perfomed for 38 cases of bladder neoplasms after total cystectomy. RESULTS All cases have been followed up 6-42 months with a mean of 32 months. Good continence has been achieved during day time in all(100%)and at night in 96% in 12 months after operation. The mean urin quantity of every times was 585.6mL in 12 months after operation/The mean filling pressure of pouth was 1.62kPa and the pressure during voiding was 4.60kPa.The uroflow rate has been good with the mean maxinal flow rate of 17.3mL·s-1 in 20 patients/There has been no evidence of ureterel reflux and narrow.The renal function,serum electrolytes and urin test has been normal. 1 patients died for cerbral haemorrhge. CONCLUSION The globular content ortholopic ileal neobladder is feasible for patients after total cystectomy. It provides a large capacity,low intareservoir pressure,contient uriane reseruoir with low complication rate thus improving the life quality of atients.