全膀胱切除-回肠新膀胱术26例报告

摘要

目的：探索全膀胱切除术后保留较好生活质量的手术方法。方法：按经典方法行全膀胱切除术，但术中尽量保留膀胱外括约肌及膜部尿道，并取约60cm带血管蒂的末段回肠，于肠系膜对侧缘纵形剖开形成肠片，再将该肠片以"W"形折叠，缝合为球形的新膀胱。双侧输尿管断端吻合于球形新膀胱，新膀胱的底部与尿道残端吻合。结果：1994．4～2000．4进行该手术26例。其中23例术后能自控排尿，无尿失禁，每次排尿量200～600mL。3例术后排尿困难。所有患者术后血电解质基本正常。B超检查无肾、输尿管扩张积水。膀胱造影无膀胱输尿管返流。膀胱尿道镜检查无尿道肿瘤复发。结论：回肠新膀胱术术后有良好的排尿功能，膀胱容量大、压力低、自控排尿功能好，术后并发症少，是浸润性膀胱癌手术方式的一个优良选择。%Aim: To improve the quality of live of patients who suffered from bladder cancer after radical cystectomy. Methods: The radical cystectomy based on the classical method was done. During the operation, the sphincter of urethra and membranous urethra was especially preserved. It was performed to obtain a lower pressure system, disruption of directional bowel peristalsis with a longitudinal incision at the antimesenteric border of a 60cm of terminal ileal segment. This ileal segment was folded on "W" type and re-sutured to create a spherical-shaped intestinal pouch, the neobladder. The bilateral ureters were anastomosed to this neobladder. The bottom of this neobladder was anastomosed to the urethral remnant. Results: From Apr. 1994 through Apr. 2000, twenty- six patients were treated by the above operating procedure. Among these patients, twenty - three cases showed that voiding spontaneously, day and night continence, the volume per voiding about 200 mL to 600 mL. Only three cases were difficult in voiding. In all cases, the serum electrolyte level indicated almost normal. Neither hydronephrosis nor residual urine was seen on ultrasonic examination and no vesico - ureteral reflux had been disclosed by voiding cystography, All patients had not any tumor in survivals of the urethra by cystoscopy been disclosed postoperative. Conclusion: The ileal neobladder had excellent functional voiding outcome after cystectomy, It has a big volume, low pressure, spontaneously voiding, less complication. It would offer an attractive choice for a bladder substitute when radical cystectomy is required.