Objective To retrospectively review the urodynamic changes of modified Studer ileal bladder substitute after radical cystectomy.Methods A total of 49 consecutive patients (33 male,16 female) who underwent radical cystectomy followed by construction of an orthotopic ileal pouch regularly one year after operation were enrolled.The urodynamic data were analyzed.Results All patients received at least 2 urodynamic tests,among which 21 received 3 urodynamic tests.The 3-month,6-month and 12-month follow-up data of urodynamic changes were compared.The maximum bladder capacity was (274.0±88.3 vs.296.7±91.3 vs.350.5±98.0) mL,maximum bladder pressure during filling was (31.1±13.9 vs.27.8±20.2 vs.19.6 ± 12.8) cmH2 O,and bladder capacity when neobladder contraction occurred during filling was (139.0 ± 71.0 vs.150.5±85.5 vs.210.1±76.9) mL.There were significant differences between the 6-month and 12-month data (P＜0.05).There were no significant differences in the maximum flow rate (9.1±5.1 vs.8.5±4.8 vs.8.6±±5.5) mL/s,residual urine (22.5± 53.8 vs.36.1 ±80.0 vs.21.0±46.2) mL,maximum urethral closure-pressure (59.8±26.2 vs.69.6±42.2 vs.71.7±46.7) cmH2O,and functional urethral length (31.5±8.5 vs.32.1±9.9 vs.30.5±9.8) mm.In the 12-month followup data,there were significant differences in male and female maximum urethral closure-pressure (88.6 ± 54.5 vs.49.1 ± 22.3) cmH2O,and functional urethral length (34.6±9.5 vs.24.0±6.4) (P＜0.05).Conclusion The modified Studer ileal neobladder,which has an appropriate capacity,low-pressure reservoir and favorable compliance,is a comparatively ideal urinary diversion.Besides,the function of neobladder gradually improves.%目的 回顾性分析行根治性膀胱全切术+改良Studer回肠新膀胱术后早期连续尿动力学变化特征.方法 选取因患膀胱癌而行根治性膀胱全切术+改良Studer回肠新膀胱术术后早期(术后1年以内)规律行尿动力学检查的患者49例,对比分析其尿动力数据.结果 共有49例患者(男33例,女16例)至少在术后早期规律完成两次尿动力学检查,其中21人规律完成3次尿动力学检查.术后第3月、6月及12月尿动力学检查中最大膀胱容量(274.0±88.3 vs.296.7士91.3 vs.350.5±98.0)mL、充盈期最大膀胱压(31.1±13.9 vs.27.8±20.2 vs.19.6±12.8)cmH2O、充盈期新膀胱出现收缩时新膀胱容量(139.0±71.0 vs.150.5±85.5 vs.210.1±76.9)mL,其中术后第6月及12月尿动力学参数比较有统计学差异(P＜0.05);然而最大尿流率(9.1±5.1 vs.8.5±4.8 vs.8.6±5.5)mL/s、残余尿量(22.5±53.8 vs.36.1±80.0 vs.21.0±46.2)mL、最大尿道关闭压(59.8±26.2 vs.69.6±42.2 vs.71.7±46.7)crnH2O、功能尿道长度(31.5±8.5 vs.32.1±9.9 vs.30.5±9.8)mm无统计学差异(P＞o.05).在术后12月,男性最大尿道关闭压(88.6±54.5)cmH2O、功能尿道长度(34.6±9.5) mm分别与女性最大尿道关闭压(49.1±22.3)cmH2O、功能尿道长度(24.0±6.4)mm相比较有显著性统计学差异(P＜0.05).结论 改良Studer回肠新膀胱术是一种理想的尿流改道方式,具有适当容量、低内压、良好顺应性特点,且随着时间的推移新膀胱的功能不断完善.
展开▼
