回肠新膀胱术60例报告  

Report of 60 cases with ileal neobladder

作　　者：黄国华[1] 葛根[1] 潘正跃[1] 孙锡林[1] 吴勇[1] 习小庆[1] 史子敏[1] 

机构地区：[1]江西医学院第二附属医院泌尿外科,南昌330006

出　　处：《中华泌尿外科杂志》1999年第12期740-742,共3页Chinese Journal of Urology

摘　　要：目的　总结１０ 年来行回肠新膀胱术的手术体会。　方法　对６０ 例行回肠新膀胱术患者进行尿流可控性、尿动力学、影像学、核医学及生化检查，手术并发症及生存情况的随访观察。随诊时间６ ～９６ 个月，平均３ 年。　结果　病人白天均可自控排尿，仅有２ 例夜间尿失控。尿动力学检查显示新膀胱容量为２５０ ～４００ｍｌ（ 平均３００ｍｌ） ，膀胱充盈时最大内压１５ ～２５ｃｍＨ２Ｏ（ 平均２０ｃｍ Ｈ２Ｏ） ，排尿膀胱压力为５０ ～７０ｃｍ Ｈ２Ｏ（ 平均５６ｃｍ Ｈ２Ｏ） ，平均最大尿流率１６ｍｌ／ｓ，剩余尿为０ ～１２０ｍｌ（ 平均２０ｍｌ） 。影像学检查仅发现２ 例上尿路轻度扩张，肾功能均正常，无电解质紊乱现象，肾图无梗阻。再次手术修补尿瘘２ 例，肾盂输尿管轻度扩张２ 例，围手术期死亡１ 例。肿瘤转移死亡１２ 例，尿道肿瘤复发１ 例，与肿瘤无关死亡３ 例。　结论　对于肿瘤未侵犯前列腺或尿道的膀胱肿瘤病人和结核性挛缩小膀胱的病人，回肠新膀胱是一种低并发症的膀胱替代手术方法。Objective To present an 10 year experience with ileal neobladder. Methods 60 cases of ileal neobladder have been followed up for 6～96 months with a mean of 3 years.The follow up studies included the observation of urine continence and looking for any complication,urodynamic studies,radiologic examinations,radionuclide imaging,and laboratory examinations.The neobladder was constructed for 52 bladder carcinoma patients after total cystectomy and for 8 with tuberculous contracted bladder. Results All the patients have been continent during daytime only 2 of them being incontient at night.The capacity of the neobladder was 250～400ml with a mean of 300ml and the maximal intrareservoir pressure during filling was 15～25cm of H 2O with a mean of 20cmH 2O.The pressure during voiding was 50～70cmH 2O with a mean of 56.The uroflow rate has been good in all with the maximal flow rate of 16ml/s.The residual urine volume was 0～120ml with a mean of 20ml.Dilatation of the upper urinary tract on radiologic examination was observed in only 2.Renal function and other laboratory findings have been normal and no electrolyte disorder was found.2 patients needed a repair of fistuli but no obstruction of the urinary tract was observed on radionulide imaging.1 paitient died shortly after operation,12 died of cancer metastasis and 3 died of diseases unrealted to the carcinoma.1 patient suffered from an urethral recurrence. Conclusions Ileal neobladder is feasible for patients after total cystectomy or for small tuberculous contracted bladder with low complication rate.

关 键 词：尿流改道 回肠新膀胱 膀胱肿瘤 外科手术 

分 类 号：R737.140.5[医药卫生—肿瘤] R730.56[医药卫生—临床医学]