膀胱全切Bricker术与Studer原位膀胱术8年的随访和评价  

Bricker conduit and Studer orthotopic ileal neobladder after radical cystectomy:8-year follow-up and evaluation

作　　者：毛士玉 黄天宝[1] 熊大波 徐亮[1] 叶定伟[2] 郑军华[1] 姚旭东[1] 

机构地区：[1]上海市第十人民医院泌尿外科,上海200072 [2]复旦大学附属肿瘤医院泌尿外科,上海200032

出　　处：《现代泌尿外科杂志》2016年第3期170-173,共4页Journal of Modern Urology

基　　金：国家自然科学基金(No.81272836)

摘　　要：目的本研究通过长期对患者各方面检查和随访,评价两种术式在膀胱癌全膀胱切除术中临床应用效果。方法从2005年4月至2013年8月,363例膀胱癌全膀胱切除术患者中行Studer原位膀胱术97例,Bricker术266例,比较不同术式患者的临床基线资料、术后早期、晚期并发症发生情况。结果 Studer组和Bricker组在不全肠梗阻、尿道肿瘤复发、术后吻合口狭窄、低血钾性行走无力方面差异无统计意义（P〉0.05）,2组在排尿困难、膀胱结石方面差异均具有统计学意义（P〈0.05）。Studer组排尿情况：术后早期均有不同程度的尿失禁,6周后恢复控尿;有不同程度的排尿困难,3例临时导尿,与黏液堵塞出口有关;新膀胱容量前3月100~200mL,术后半年200~350mL,1年后350~500mL,平均450mL;残余尿量10~100mL,平均30mL。两组患者随访肾功能、电解质、肝功等,静脉造影无明显差异。结论相比Bricker术,Studer原位膀胱术在肿瘤特异生存和手术并发症方面无明显差别。然而,Studer原位膀胱术可达到极好地自主排尿,是一种生活质量较高的尿流改道方式,因此是临床可首先选择的膀胱重建术。Objective To compare the clinical outcomes of Bricker ileal conduit and Studer orthotopic ileal neobladder through8-year follow-up.Methods A total of 363 cases of bladder cancer treated during April 2005 and August 2013 were enrolled,including 97 cases of Studer orthotopic ileal neobladder（Studer group）and266 cases of Bricker ileal conduit（Bricker group）.The clinical data,early and late complications were retrospectively analyzed.Results No demonstrable difference was found in incomplete intestinal obstruction,urethral recurrence,anastomotic stenosis,and powerless for hypokalemia between the two groups（P〉0.05）.Incidences of cystolith and dysuria in Bricker group were significantly lower than those of the Studer group（P〈0.05）.In Studer group,all patients had different degrees of urinary incontinence and dysuria,and3 patients underwent temporary urethral catheterization.The neobladder maximum capacity was 100~200 mL after 3 months,200~350mL after 6 months,and 350~500 mL after 1 year（average 450 mL）.Residual urine volume was 10~100 mL.No difference was observed in renal function,electrolyte,liver meritorious service and vein angiography between the two groups.Conclusions Compared with Bricker diversion,Studer orthotopic diversion has no obvious superiority in tumor-specific survival and postoperative complications.However,it can help self-voiding and is an effective way of urinary diversion.

关 键 词：膀胱肿瘤 根治性膀胱切除术 尿流改道 Studer原位新膀胱 Bricker回肠膀胱 

分 类 号：R694[医药卫生—泌尿科学]