改良全膀胱切除原位新膀胱术96例报告  

Modified total cystectomy and neobladder: experience with 96 cases of invasive bladder cancer

作　　者：周芳坚[1] 刘卓炜[1] 余绍龙[1] 韩辉[1] 秦自科[1] 李永红[1] 王欢[1] 

机构地区：[1]华南肿瘤学国家重点实验室中山大学肿瘤防治中心泌尿外科,广州510060

出　　处：《中华泌尿外科杂志》2006年第8期549-551,共3页Chinese Journal of Urology

摘　　要：目的总结改良全膀胱切除原位新膀胱术治疗浸润性膀胱癌的临床经验。方法采用改良全膀胱切除原位新膀胱术治疗局部浸润性膀胱癌患者96例,患者均为男性,平均年龄55岁。96例中移行细胞癌91例,WHO分级Ⅲ级39例、Ⅱ级51例、Ⅰ级1例;鳞癌3例;腺癌2例。肿瘤多发92例(移行细胞癌91例、腺癌1例),单发4例(鳞癌3例、腺癌1例)。TNM临床分期T2N0M0 88例,T3N0M06例,T3N1M0 2例。统计手术时间、术中出血和输血量,对新膀胱功能、并发症、肿瘤控制和患者生存情况进行随访分析。结果96例患者无手术死亡,手术时间190—330min,平均260 min。术中出血150～1200 ml,输血30例。病理分期T1N0M0 1例,T2N0M0 89例,T3aN0M0、T3aN1M0和L3bN1M0各2例。随访5～58个月,平均31个月。无瘤生存94例,因肿瘤死亡2例。新膀胱白天控尿良好93例(97％),夜间控尿良好80例(83%)。剩余尿量0—80 ml者87例,100～250 ml者7例。主要并发症:切口裂开3例,二次缝合治愈;输尿管吻合口漏1例,再吻合后治愈;输尿管口狭窄2侧和输尿管口粘连4侧,经内镜下手术纠正;严重肠梗阻3例和慢性酸中毒低钾2例均经内科处理纠正。无严重远期并发症。结论改良全膀胱切除原位新膀胱术后肿瘤控制满意,严重并发症少,新膀胱控尿良好,患者生活质量高,是目前治疗浸润性膀胱癌的理想方法之一。Objective To report our clinical experience of modified total cystectomy and neobladder in patients with invasive bladder cancer. Methods Totally,96 male patients （mean age,55 years） with invasive bladder cancer were treated with modified total cystectomy and neobladder. Transitional cell carcinoma （TCC） was identified in 91 cases （grade Ⅰ in 1 case,grade Ⅱ in 51 cases and grade Ⅲ in 39 cases）; adenocarcinoma in 2 cases and squamous cell carcinoma in 3 cases. Multiple tumors were found in 92 patients and solitary tumor in 4. As for TNM clinical stage,88 cases had T2N0M0 tumor,6 had T3N0M0 tumor and 2 had T3 N1M0 tumor. The data of operative time,blood loss and blood transfusion volume were collected. The outcomes of patients,including neobladder function,complications, tumor control and survival, were analyzed. Results There was no surgical mortality. The operative time was 190 -330 min （mean,260 rain）. Blood loss was 150 - 1200 ml and blood transfusion was required in 30 cases. Pathological staging revealed T1N0M0 tumor in 1 case,T2N0M0 tumor in 89,T3aN0M0 tumor in 2,T3a N1M0 tumor in 2 and T3bN1M0 in 2. The follow-up was 5 - 58 months （ mean ,31 months）. Of the 96 patients ,94 survived disease-free and 2 died of metastasis. Ninety-three patients （97%） were continent at daytime and 80（83% ） were continent nocturnally. Residual urinary volume was 0 -80 ml in 87 cases and 100 -250 ml in 7. Complications,including wound dehiscence in 3 cases,stenosed anastomosis in 2 ureters,urine leakage at anastomosis in 1 ureter and conglutination of ureter orifices in 2 cases （ on both sides） , were corrected surgically without sequela. Three cases developed ileus and 2 developed chronic acidotic hypokalemia,which were treated by conserva tive therapy successfully. There was no severe long-term complication. Conclusions Modified total cystectomy and neobladder is an ideal method for treating invasive bladder cancer because of its excellent clinicaloutcome of tumor control, high quality of l

关 键 词：膀胱肿瘤 癌 膀胱切除术 

分 类 号：R737.14[医药卫生—肿瘤] R699.5[医药卫生—临床医学]