改良根治性全膀胱切除原位新膀胱术(附9例报告)  

Modified radical cystectomy and ileal orthotopic neobladder (report of 9 cases)

作　　者：黄洪才[1] 周芳坚[2] 吴宝国[1] 黎建欣[1] 方海林[1] 张朝胜[1] 钟晓健[1] 曹正国[1] 

机构地区：[1]汕头大学医学院附属粤北人民医院泌尿外科,韶关512026 [2]中山大学肿瘤防治中心泌尿外科

出　　处：《现代泌尿生殖肿瘤杂志》2012年第4期210-212,共3页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的探讨改良根治性全膀胱切除原位新膀胱术的临床疗效。方法采用改良全膀胱切除回肠新膀胱术治疗浸润性膀胱癌9例,均为男性,年龄40～64岁,平均55岁。尿路上皮癌8例,按WHO分级标准,Ⅱ级5例,Ⅲ级3例;腺鳞癌1例。肿瘤多发6例,均为尿路上皮癌,肿瘤最大径1.5～11.0cm。TNM临床分期:T2N0M07例,T3N0M01例,T4N1M01例。结果手术时间210～330min,平均260min。术中出血量200～800ml。输血5例,输血量400～600ml。病理分期:T2aN0M05例,T2bN0M01例,T4aN0M02例,T4N2M01例。9例患者术后均获得随访,随访时间10～64个月。7例无瘤生存,肾功能良好;2例术后2年死亡(1例腺鳞癌者死于全身转移,1例死于意外事故)。所有病例白天控尿均良好,夜间控尿良好5例,剩余尿量0～50ml。1例术后出现上尿路扩张积液、肾功能不全,为两侧输尿管末端粘连所致,经内镜下粘连松解后积液消退,肾功能恢复正常。2例年龄<50岁者,术后6个月有阴茎勃起,服用西地那非片可完成性活动。结论改良根治性全膀胱切除原位新膀胱术是治疗浸润性膀胱癌的理想方法之一。Objective To evaluate the clinical effect of the modified radical cystectomy and ileal orthotopic neobladder. Methods Totally, 9 male patients （mean age, 55 years old） with invasive bladder were treated with modified radical cystectomy and ileal orthotopic neobladder. Transitional cell carcinoma was identified in 8 cases （grade Ⅱ in 5 cases, grade Ⅲ in 3 cases）, adenosquamas carcinoma in 1 case. Multiple tumors were found in 6 patients, and among them the maximum tumor diameter was 1.5-11.0 cm. As for TNM clinical stage, 7 cases had T2N0M0 tumor, 1 case had T3N0M0 tumor, 1 case had T4N1M0 tumor. Results The operative time were 210-330 min （mean, 260 min）. Blood loss were 200-800 ml. Blood transfusion was required in 5 cases, and volumes of blood transfusion were 400-600 ml. Pathological staging revealed T2aN0M0 tumor in 5 cases, T2bN0M0 tumor in 1, T4aN0M0 tumor in 2, T4N2M0 tumor in 1. The follow-up were 10 to 64 months. Of the 9 patients, 7 survived disease-free and renal functions were normal, 1 died of metastasis and 1 died of accident. All patients were continent at daytime and 5 cases were continent nocturnally. Residual urinary volumes were 0-50 ml. Upper urinary tract obstruction and insufficiency of renal function due to conglutination of ureteral orifice in 1 case was corrected endourological surgery without sequela. Two patients less than 50 years of age restored erection for intercourse with Sildenafil. Conclusions Modified radical cystectomy and ileal orthotopic neobladder is the one of the ideal methods for treating invasive bladder cancer.

关 键 词：膀胱肿瘤 膀胱切除术 

分 类 号：R737.14[医药卫生—肿瘤]