回肠原位新膀胱术后10年以上患者随访  

Long term follow up of patients with the ileal orthotopic neobladder

作　　者：邱学德[1] 徐鸿毅[1] 石永福[1] 李泽惠[1] 李炯明[1] 王剑松[1] 李志鹏[1] 方克伟[1] 曾贵华[1] 李海丹[1] 何进[1] 和术臣[1] 

机构地区：[1]昆明医学院第二附属医院泌尿肾病外科云南省泌尿外科研究所,650101

出　　处：《中华泌尿外科杂志》2009年第10期677-680,共4页Chinese Journal of Urology

摘　　要：目的总结回肠原位新膀胱手术的远期效果。方法1991至1998年共施行回肠原位新膀胱手术79例。男73例，女6例。平均年龄55（41～75）岁。术后随访时行肾功能、电解质、血常规等测定，B超测定残余尿，作IVU或MRU检查；测量术后5、10～14和15年患者。肾盂最大横径和膀胱最大垂直和水平径线，不同时段结果间作两两比较；观察肿瘤局部或远处是否复发以及手术并发症等。结果获随访64例。男58例，女6例。平均随访167（121-216）个月。死于非肿瘤原因7例，肿瘤盆腔复发7例，尿道复发2例，死于肿瘤远处转移3例，输尿管再发肿瘤1例，新膀胱再发肿瘤1例。存活时间〉10年者48例，术后5、10-14和15年患者SCr、BUN、K^＋、Na^＋、Cl^-、Ca^2＋和血红蛋白测定均在正常值范围，且不同时段间比较差异无统计学意义（P〉0．05）；5、10～14和15年平均肾盂最大横径分别为14．0、14．1和13．7mm（P〉0．05）；平均膀胱最大垂直径线分别为110．4、111．5和127．0mm，水平径线分别为90．4、95．3、97．0mm（P〉0．05）。残余尿〉50ml者5例，随访期间残余尿量均未见明显增加。发生新膀胱结石8例，经腔内碎石治愈；尿道狭窄2例，经内切开治愈；腹股沟疝14例，再手术治愈12例。无与手术或肿瘤有关并发症者17例。结论回肠原位新膀胱术后上尿路和新膀胱功能能够保持长期稳定，肿瘤治愈率满意，但术后需要终身随访。Objective To discuss the long term clinical effect of ileal orthotropic neobladder. Methods From 1991 to 1998, 79 patients, mean age 55（41-75） years, male 74, female 6, were followed up. The serum creatinine and urea, electrolytes, blood routine, B ultrasonic scan of the neobladder residual urine and IVU or MRU of the patients were followed up. The max transverse diameter of renal pelvis and the max vertical / level diameter of neobladder were measured in 5, 10 to 14, 15 years of postoperative when IVU or MRU. All results of different time were compared by the multiple comparisons. The local or distant cancer recurrence and the complications of the operation were evaluated. Results Sixty-four cases, 58 male, 6 famle, were long term followed up; mean time was 167 （range, 121-216）months. Seven cases died of other diseases. Seven cases had pelvic recurrence. Two cases had urethral recurrence. Three cases died of tumor metastasis. One case had ureter recurrence. Forty-eight patients were alive more than 10 years. The value of the serum creatinine, urea, electrolytes and bloods routine of the patients were normal after 5, 10 to 14 and 15 years postoperative （P〉0.05）. The max transverse diameter of the renal pelvis in 5, 10 to 14 and 15 years postoperative were 14.0 mm, 14.1 mm and 13.7 mm,respectively, P〉0.05. The max vertical / level diameter of the neobladder in 5, 10 to 14, 15 years of postoperative were 110.4 mm/90.4 mm, 111.5 mm/95.3 mm and 127.0 mm/97.0 mm,respectively, P〉0.05. The residual urine of 5 cases was more than 50 ml and had not increased during follow up. Eight cases with neobladder stone were cured by the intracavitary lithotbrypsis. Two cases with uretheral stricture were cured by the intracavitary therapy. Twelve cases of 14 cases with inguinal hernia were cured by reoperation, 2 cases accepted conservative treatment. Only 17 cases had no complication involve of the cancer and the operation. Conclusion The upper urinary tract and neobladder of the ileal orthotopic neobladder could

关 键 词：膀胱肿瘤 回肠 原位新膀胱 随访研究 

分 类 号：R686[医药卫生—骨科学]