Studer回肠代膀胱术的技术改进和临床应用

Technical refinements and clinical application of Studer neobladder

目的 探讨Studer回肠代膀胱术技术改进的临床应用价值。 方法 对Studer回肠代膀胱术进行技术改进 ,包括缩短输入道回肠、先作成贮尿囊和完成输尿管与输入道吻合口 ,最后贮尿囊尿道 6针吻合、代膀胱前壁与耻骨悬吊固定等 ,并应用于 35例患者。膀胱癌 31例 ,晚期神经原性膀胱 2例 ,腺性膀胱炎 2例。患者均为男性 ,平均年龄 6 1岁。随访观察术后并发症、排尿功能和生活质量。 结果 35例手术时间 5 .5～ 8.5h ,平均 6 .5h。术中出血量 30 0～ 12 0 0ml,平均 6 5 0ml,术中需输血 2 1例。围手术期发生应激性溃疡 6例 ,成人呼吸窘迫综合征 (ARDS) 1例。患者术后均恢复生理排尿 ,剩余尿 4 0～ 6 0ml者 5例 ,术后 3个月和 6个月的白天控尿率分别为 91%和 10 0 % ,夜间控尿率分别为 87%和 96 %。上尿路功能良好 ,生活质量满意。 结论 Studer回肠代膀胱术技术相对简单、并发症少、术后恢复快、符合生理性排尿、疗效满意 ,值得临床推广应用。

Objective To evaluate the clinical value of modified Studer ileal neobladder. Methods Technical refinements on Studer ileal neobladder have been divised and applied to 35 patients of which 31 with multiple or invasive transitional cell carcinoma of bladder,2 advanced stage of neurogenic bladder and 2 extensive polypoid cystitis glandularis.All patients were male,with an average age of 61 years. Results Mean operative time was 6.5 hours (range 5.5～8.5 hours),mean intraoperative blood loss was 650 ml(range 300～1 200 ml),and transfusion was needed in 21 case.Perioperative complications included stress ulcer in 6,ARDS in 1.Follow-up ranged from 3 to 38 month.All the patients voided without difficulty,only 5 patients had small amount of residual urine (40～60 ml).The day time urinary continent rates at 3 months and 6 months postoperatively day time were 91% and 100% and the night time 87% and 96%,respectively.The upper urinary tract function was excellent.Mean capacity of the ileal neobladder was 410 ml,maximal filling pressure 21.4 cmH 2O,and Qmax 16.8 ml/s in 6 months postoperatively. Conclusions Modified Studer ileal neobladder has advantages of technically simple,lower complication rate,shorter recovery time and similar to physiological voiding.It is recommended to be widely used in selective candidates.