老年男性原位膀胱重建术患者尿动力学功能评价  

Performance evaluation of orthotopic bladder reconstruction with ileocecum-appendix evaluated by imaging urodynamics

作　　者：王绍勇[1,2] 宋鸿彬[1,2] 周春文[1,2] 林海群[3] 

机构地区：[1]山东大学泌尿外科研究所,济南250031 [2]山东大学第二医院泌尿外科,济南250031 [3]山东省肿瘤医院放射肿瘤科

出　　处：《中华老年医学杂志》2011年第5期387-389,共3页Chinese Journal of Geriatrics

基　　金：山东省中青年科学家奖励项目（2008BS03053）

摘　　要：目的探讨应用尿动力学方法评估回盲结肠膀胱原位重建术在老年膀胱癌患者中的应用价值。方法应用回盲肠及部分升结肠作储尿囊，以阑尾根部与后尿道吻合原位排尿的方法治疗膀胱肿瘤患者12例，应用尿动力学方法对其近期疗效进行随访。结果12例中11例患者能达到完全控尿，1例有尿失禁，3例有夜间尿失禁。多数患者能达到控尿目的。术后3个月内白天排尿次数8～10次，夜间3～5次；6个月后白天平均4～6次，夜间0～2次。每次量约l50～350ml。术后6个月～1年分别随访12例患者。尿动力学结果显示：平均尿流率10．5ml／s，平均膀胱初始感觉压力27cmH2O（1cmH2O=0．098kPa），最大充盈压35cmH2O，其储尿囊容量分别为152ml、420ml。后尿道闭合压力为52cmH2O，残余尿量0～65ml。结论正位膀胱重建术具有储尿囊内压低、容量大、可控性和原位排尿的特点，是一种较理想的尿流改道方式。Objective To evaluate the effect of the urinary reservoir constructed with ileocecum appendix in the elderly with bladder cancer. Methods From March 2002 to June 2008, 12 cases were treated using ileocecum-appendix as the reservoir after radical cystectomy. They all received the imaging urodynamics examination and were followed up for 1 year. Results The 11 of 12 patients had urinary continence completely. Only 1 case had incontinence and 3 cases had incontinentia urinae at night. Times of uresis were 8-10/day and 3-5/night within 3 months after surgery, and 4-6/day and 0-2/night 6 months after surgery. The urinary output was 150-350 ml/time. Urodynamics showed that mean urinary flow rate was 10.5 ml/s, mean initial bladder pressure was 27 cm HeO, the maximum filling pressure was 35 cm H2O. The average reservoir capacity was 152 ml and 420 ml, respectively. The out let pressure of posterior urethra was 52 cm H20. The volume of residual urine was 0-65 ml. No evidence of ureteral reflux occurred, no hyperchloremic acidosis was observed. Conclusions Orthotopic bladder reconstruction is considered as an ideal form of urinary diversion characterized by low pressure, larger capacity and continence.

关 键 词：膀胱肿瘤 尿流改道术 尿动力学 

分 类 号：R737.14[医药卫生—肿瘤]