回肠新膀胱术治疗膀胱癌(附61例报告)  

Orthotopic ileal neobladder in treatment of bladder cancer: a report of 61 cases

作　　者：张海民[1] 郑军华[1] 黄国华[1] 段建敏[1] 巢月根[1] 许云飞[1] 彭波[1] 鄢阳[1] 高其若[1] 崔玉芬[1] 

机构地区：[1]同济大学附属第十人民医院泌尿外科,上海200072

出　　处：《第二军医大学学报》2007年第10期1064-1067,共4页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(30270522);上海市科委基金(054119604).~~

摘　　要：目的：回顾分析行回肠新膀胱术治疗膀胱移行细胞癌的手术体会及长期随访结果。方法：从1988年1月至2006年12月,共有61例膀胱移行细胞癌患者行根治性膀胱切除＋回肠新膀胱术。回肠新膀胱术采用回肠末端肠段,作对系膜缘切开,然后将回肠片U形排列缝合,间断内翻缝合重建膀胱颈,输尿管行黏膜沟再植。对患者的围手术期死亡率、并发症、尿控情况、肾功能、影像学及尿动力学检查结果进行评估。结果：除1例围术期死亡外,其余患者随访12~168个月。共死亡13例。并发症为肾功能不全11例、输尿管新膀胱吻合口狭窄9例、膀胱输尿管反流6例、尿漏5例、出血4例、切口疝4例、尿道狭窄3例、尿道复发1例。42例患者尿控效果满意。结论：经过长期随访,我们提出的新型原位回肠膀胱术是一种效果良好、并发症较低的尿道改道术,有一定的临床应用价值。Objective：To summarize our clinical experience on treating bladder transitional cell carcinoma with orthotopic ileal neobladder after radical cysteetomy and to report the long-term follow-up results. Methods： From Jan. 1988 to Dec. 2006, 61 patients （49 male and 12 female） with a mean age of 64.0±5.6 years （range 54 to 78） were subjected to orthotopic ileal neobladder construction after cystectomy. The entire length of ileum was opened along the antimesenteric border, placed into a transverse ＂U＂ shape, and sutured with a running suture. The lateral borders of the ＂U＂ shape bottom were used to surround the urethra and were sutured with the interrupted suture from ＂inside＂ the neobladder for the ileourethral anastomosis. The ureters were implanted from inside the neobladder through a small incision into the ileum at a convenient site, and were embedded in a mucosal sulcus. The perioperation mortality, complications, urinary continence, renal function, image findings, and urodynamic examination were all retrospectively evaluated. Results： One patient （1.6%） died during perioperation period and all the others were followed up for 12-168 months. Totally 13 patients （21.3%） died during follow-up. The complications included renal inadequacy （11 patients）, ureteroileal obstruction （9 patients）, ureteral reflux （6 patients）, urine leakage （5 patients）, bleeding （4 patients）, incisional hernia （4 patients）, urethral stricture （3 patients）, and urethral recurrence （1 patient）. After 60 months follow-up, 42 patients had a satisfactory urinary continence. Conclusion： After long-term follow-up, we conclude that the ileal neobladder is a satisfactory method for treatment of invasive bladder cancer after radical cystectomy; it has less complication and is clinically valuable.

关 键 词：膀胱肿瘤 膀胱切除术 尿流改道术 回肠 

分 类 号：R737.14[医药卫生—肿瘤]