改良W形回肠代膀胱术的疗效观察(附36例报告)

Modified W shaped orthotopic ileal neobladder (Report of 36 cases)

目的 :探讨改良W形回肠代膀胱术的疗效。方法 :对 36例膀胱肿瘤患者行根治性膀胱切除、W形回肠代膀胱术 ,并对术式进行改进。结果 :36例手术时间平均 4 .2h。术后 31例随访 4～ 19个月 ,平均 10 .6个月 ,无严重并发症 ,均无瘤生存。患者一般于术后 3周自主可控性排尿 ,日间尿控率为 10 0 % ,术后 3、6、12个月夜间尿失禁发生率分别为 2 2 .5 %、11.1%及 6 .2 %。术后 6个月尿动力学检查膀胱容量 (36 0± 30 )ml,最大尿流率 (13.6± 2 .6 )ml/s,剩余尿量 (11.5± 5 .8)ml,充盈期膀胱压力明显低于尿道闭合压。新膀胱造影发现新膀胱呈球形 ,完全位于盆腔 ,未见输尿管反流。B超及IVU检查发现原上尿路积水 4例均明显减轻 ,其余未发现输尿管狭窄和上尿路积水征象。无高氯性酸中毒 ,肾功能正常。结论 :改良W形回肠代膀胱术手术时间短 ,操作简单 ,创伤轻 ,并发症少 ;新膀胱容量大 ,内压低 ,顺应性好 ,功能接近于正常膀胱 ,保持原位排尿 ,明显提高了患者术后生活质量 ,值得临床推广应用。

Objective:To evaluate the effect of the modified W-shaped orthotopic ileal neobladder after total cystectomy for the management of bladder cancer.Methods:The data of 36 cases of bladder cancer managed by a modified W-shaped orthotopic ileal neobladder after total cystectomy were reviewed and analyzed.Results:The operation time was 3.5 to 5.5 hours with a mean of 4.2 hours. 31 of 36 patients have been followed up after operatio for 4 to 19 months with a mean of 10.6 months, no serious operative complications occurred, all these patients were survival with no recurrance. The daytime urinary continence rate was 100% and the nocturnal incontinence rate at 3,6,12 months after operation were 22.5%, 11.1% and 6.2%, respectively. Urodynamics carried out at 6 months after operation showed that the average capacity of the urinary reservoir, the peak urinary flow rate and residual urine volume were 360 ml, 13.6 ml/s and 11.5 ml, respectively, and the intrareservoir pressure was significant lower than the intraurethra pressure. No evidence of ureteral reflux, ureteral stricture and hyperchloremic acidosis have been observed.Conclusions:The modified W-shaped orthotopic ileal neobladder has the advantages of a large capacity,low intrareservior pressure,good continence,little harm to the host and less complications.and it takes less time and is more feasible.