可控性尿流改道与原位肠代膀胱的临床应用研究  

Clinical study of continent diversion and orthotopic neobladder

作　　者：王允武[1] 张书贤[1] 郭松林[1] 

机构地区：[1]皖南医学院第二附属医院泌尿外科,安徽芜湖241000

出　　处：《临床泌尿外科杂志》2012年第5期321-323,共3页Journal of Clinical Urology

基　　金：安徽省临床医学应用技术计划项目(No:06B004)

摘　　要：目的:为膀胱全切术后的患者提供更好的控尿术式。方法:回顾性分析1998～2010年间28例可控性尿流改道(可控性回结肠膀胱)和21例原位肠代膀胱的并发症发生率及其对患者生活质量的影响。可控性回结肠膀胱组前9例行Indiana术式,后19例行改良的Indiana术式。原位肠代膀胱组采用乙状结肠或"W"形回肠纵行剖开制成贮尿囊。结果:本研究组49例均获得随访,随访时间6个月～12年。可控性回结肠膀胱组28例自行清洁导尿,间隔时间90～270min,平均240min。原位肠代膀胱组21例在腹压的辅助下自行排尿,排尿间隔时间150～240min,平均195min。可控性回结肠膀胱组中22例感觉生活满意或基本满意(78.6%),6例感觉生活不便(21.4%);9例出现并发症(32.1%)。原位肠代膀胱组中19例患者感觉生活满意(90.5%),2例感觉不满意(9.5%),均为压力性尿失禁;3例出现并发症(14.3%)。结论:原位肠代膀胱患者的生活质量优于可控性回结肠膀胱,术后并发症方面,原位肠代膀胱组患者并发症明显小于可控性回结肠膀胱组。Objective：To provide a better control of urinary surgical for the patients after cystectomy. Method.. Retrospective analysis the incidence of complications and its impact on patients＂ quality of life between 28 cases of continent diversion （Indiana pouch）and 21 cases of orthotopic neobladder from 1998 to 2010 in our hospital. The first 9 cases under Indiana, the latter 19 cases under the improved Indiana. In the Orthotopic neobladder group, we use the sigmoid or cut open the ＂W＂-shaped ileal to made of bladder. Result.. The study group of 49 patients were all followed up for 6 month to 12 year. In continent diversion group, 28 cases of self-clean catheterization, interval 90-270 rain, at an average of 240 rain. In Orthotopic neobladder group, 21 cases in the aid of abdominal pressure to urinate, voiding interval150-240 rain, at an average of 195 mln. In continent diversion group 22 cases were satisfied or satisfied feeling of life（78.6% ）, 6 patients feel inconvenience（21.4 % ）, 9 cases of complications （32.1 % ） in Orthotopic neobladder group, 19 cases were satisfied or satisfied feeling of life（90.5 %）, two cases of feeling dissatisfied（9.5 % ） are stress urinary incontinence, 3 patients had complications （ 14.3 % ）. Conclusion.. The patient＇s quality of life of treating with orthotopic neobladder is better than that with continent diversion group, but in the area of postoperative complications, orthotopic neobladder group were significantly less than the continent diversion group.

关 键 词：膀胱肿瘤 根治性膀胱全切术 尿流改道 

分 类 号：R737.14[医药卫生—肿瘤]