回结肠代膀胱术临床分析(附25例报告)

Orthotopic ileocolon continent urinary reservoir (report of 25 cases)

目的 探讨回结肠代膀胱术的临床疗效。 方法 对 2 5例膀胱肿瘤患者膀胱全切除术后 ,应用末段回肠及盲升结肠作贮尿囊行正位膀胱重建术。 结果 2 5例中获随访 2 2例 ,随访时间 6～ 3 4个月 ,平均 19.5个月。患者一般于术后 3周自主可控性排尿 ,日间排尿可控率 91% ,1年夜间尿失禁 2 6%。术后 6个月尿动力学检查膀胱容量 (3 86± 75)ml(2 90～ 550ml)、最大尿流率 (12 .5±2 .2 )ml/s、剩余尿量 (2 6± 11)ml ,充盈期膀胱压力明显低于尿道闭合压。输尿管返流 2例 ,无尿道狭窄、输尿管狭窄 ,无高氯性酸中毒 ,肾功能正常。 1例术后 8个月发生肿瘤多处转移 ,余 2 1例无瘤存活。 结论 回结肠代膀胱术具有膀胱容量大、内压低 ,正位排尿 ,可控性好 ,并发症少等优点 ,患者易于接受 。

Objective To evaluate the orthotopic ileo co lon continent urinary reservoir after radical cystectomy for managing bladder ca ncer. Methods 25 cases of bladder cancer managed by th e orthotopic ileocolon continent urinary reservoir after radical cystectomy wer e reviewed and evaluated. Results Of the 25 patients,22 were followed up for 6 to 34 months(mean,19.5 months).No serious operation relat ed complications occurred.The daytime urinary continence rate was 91% and the n octurnal incontinence rate 26%.Urodynamics was carried out at 6 months after ope ration.It was showed that the average capacity of the urinary reservoir,the peak flow rate and postvoid residual were 386 ml,12.5 ml/s and 26 ml respectively.Bu t the intra-reservoir pressure was significant lower than the intraurethra pres sure.Ureteral reflux occurred only in 2 cases,but no evidences of urethral or ur eteral stricture and no hyperchloremic acidosis have been observed. Conclusions Orthotopic ileocolon continent urinary reservoir might be considered as an ideal form of urinary diversion,characterized by low pressu re,large capacity,orthotopic and continent urination.