膀胱全切原位W形回肠代膀胱术120例临床分析  

The clinical study of 120 cases total cystectomy and W shape orthotopic ileal neobladder

作　　者：蔡松良[1] 陈戈明[1] 金晓东[1] 郑功[1] 赵伟平[1] 金百冶[1] 

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,杭州310003

出　　处：《中华外科杂志》2006年第2期104-107,共4页Chinese Journal of Surgery

摘　　要：目的 探讨膀胱全切原位W形回肠代膀胱术优缺点。方法120例男性膀胱癌患者，其中浸润性膀胱移行细胞癌99例，移行细胞癌伴部分鳞化8例，移行细胞癌伴腺癌及鳞癌3例，腺癌6例，鳞癌4例，均行膀胱全切原位W形回肠代膀胱术。膀胱全切采用顺行、逆行相结合的方法。截取末段回肠，排列成W形，褥式缝合制作储尿袋。输尿管以乳头法包埋术种植。结果手术时间，前50例为210-300mim，平均270min；后70例为110-205min，平均143min。术后9l例获得随访，随访2—88个月，平均30个月，85例白天可控制排尿，其中71例夜间可控制排尿。9例术后发生输尿管扩张，7例合并轻度肾积水，2例合并中度肾积水，2例肾功能轻度异常。45例行膀胱造影仅1例发生右侧输尿管返流。术后3个月复查出现低血钾者6例，余85例血电解质均在正常范围。20例患者行尿动力检查，尿流曲线呈持续型12例，间歇型8例；膀胱尿道造影显示尿流持续型代膀胱颈口呈漏斗形，排尿时开放良好，而尿流间歇形代膀胱颈口不呈漏斗形或排尿时颈口开放欠佳。结论膀胱全切原位W形回肠代膀胱术手术时间短，操作简单，出血少，并发症少，原位W形回肠代膀胱有较好的储尿和排尿功能，电解质紊乱发生率低。Objective To study advantages or disadvantages of total cystectomy and W shape orthotopic ileal neobladder. Methods Radical cystectomy and ilealneobladder was performed antegradly and retrogradly for 120 male patients. For the construction of the reservoir, the 40 cm ileal segment was isolated along its antimesenteric border and then arranged into a W shape . The incised ileum was sutured blanketly to creat urine bag The urters were replanted at the two corners of the W shape by way of ereating nipple. Results The first 50 cases took 210-300 min with a mean of 270 min. The later 70 cases took 110-205 min with a mean of 143min. Ninety-one of 120 cases had been followed up for 2-88 months with a mean of 30 months. Eighty-five cases had achieved excellent daytime continence, whereas 71 cases had nighttime continence. There were 9 cases of hydroureter and 2 cases of moderate hydronephrosis. Renal function of 2 cases were slightly abnormal. Hypokalemla occurred in 6 cases, and there was no metabolicacidosis. On voiding cystography, only 1 case showed reflux in fight ureter. Only 2 case suffered from cancer recurrence of urethal and no patient suffered from cancer recurrence of neobladder. Twenty patients were evaluated by urodynanaic examine. The urine flow curve showed continual shape in 12 cases, while intermittent shape in 8 cases. Voiding cystourethrography showed the neobladder outlet presented funnel shape and open well in continual group, while lack of funnel shape or bladder neck opened badly in intermittent group. Conclusion The modified total cystectomy and ilealneobladder are effective and reliable treatment for patients.

关 键 词：膀胱肿瘤 膀胱切除术 泌尿外科手术 治疗结果 

分 类 号：R737.14[医药卫生—肿瘤]