保存性功能的低张力Roux-y乙状结肠新膀胱21例报告  

The reserved low function stress Roux-y sigmoid neobladder(report of 21 cases)

作　　者：刘定益 夏维木 王健 王名伟[2] 张翀宇[2] 楚晨龙[2] 周文龙[2] 

机构地区：[1]上海浦南医院泌尿外科,上海200125 [2]上海交通大学瑞金医院泌尿外科,上海200025

出　　处：《中国现代医学杂志》2012年第28期62-64,共3页China Journal of Modern Medicine

基　　金：上海市浦东新区科委资助(No:PKJ2008-y22)

摘　　要：目的报告21例保留阴茎勃起神经在膀胱前列腺切除、低张力Roux-y乙状结肠新膀胱术后患者阴茎勃起中的作用。方法对21例T2a～T3a浸润性膀胱尿路上皮细胞癌患者行保留阴茎勃起神经膀胱前列腺切除和低张力Roux-y乙状结肠新膀胱术,术后6个月随访电解质、行影像学或膀胱镜和尿流动力学检查和评估国际勃起功能障碍指数(IIEF)。结果随访6个月～5年,无代谢性酸中毒,1例低血钾,肾、输尿管外形正常,无残余尿,最大尿流率为(28.83±6.96)mL/s,11例IIEF-5≥11分(52.4%),2例T3aN1术后10个月和15个月死于广泛转移。结论保留阴茎勃起神经的膀胱前列腺切除、低张力Roux-y乙状结肠新膀胱术后尿控情况良好,阴茎勃起功能尚满意。如术中注意保护副阴部动脉和采用前列腺筋膜内保留阴茎勃起神经技术有望进一步提高患者阴茎勃起功能。【Objectives】 To report the effect of penile erectile nerves sparing cystoprostatectomy and low stress Roux-y sigmoid neobladder of post-operation erection in 21 cases.【Method】 The penile erectile nerves sparing cystoprostatectomy and low stress Roux-y neobladder were performed in 21 cases of T2a～T3a invasive bladder urothelial carcinoma.The serum electrolytes,cystoscopy,radiologic、urodynamic examination and IIEF were followed up in 6 months post operation.【Result】 The follow-up time was from 6 months to 5 years.No metabolic acidosis,1 case had hypokalemia,the kidney and ureter profiles were normal,no residual urine,the Qmax is（28.83±6.96）mL/s,11 cases had IIEF-5≥11（52.4%）,2 cases of T3aN1 died from extensive metastasis 10 and 15 months post operation.【Conclusion】 The penile erectile nerves sparing cystoprostatectomy and low stress Roux-y neobladder for the bladder carcinoma have good urine continence and moderately satisfied erectile function results.The erectile function could be further improved if the vice pudendal artery was well protected and technigue of intrafascial nerve-sparing was used.

关 键 词：膀胱肿瘤 膀胱切除 尿流改道 勃起功能 

分 类 号：R737.14[医药卫生—肿瘤] R737.25[医药卫生—临床医学]