原位螺旋构型回肠新膀胱尿流动力学及感染分析  

Analysis of Urodynamic and Urinary Tract Infections of Spiral Configuration Ileum Orthotopic Neobladder after Radical Cystectomy

作　　者：沈悦凡[1] 钟欢[1] 王伟高[1] 李辉[1] SHEN Yue-fan;ZHONG Huan;WANG Wei-gao;LI Hui(Department of Urology,The First People's Hospital of Huzhou,Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州市第一人民医院泌尿外科

出　　处：《中国现代手术学杂志》2019年第3期228-231,共4页Chinese Journal of Modern Operative Surgery

基　　金：湖州市科技局公益性应用研究项目(2016GY40、2017GYB35)

摘　　要：目的 探讨根治性膀胱全切+原位螺旋构型回肠新膀胱术后患者尿流动力学及感染情况。方法 回顾性分析1998年1月~2012年12月在我院行膀胱全切+原位螺旋构型回肠新膀胱术治疗的54例膀胱癌患者的临床资料,其中尿路上皮癌50例,腺癌2例,鳞癌2例。临床病理T分期:T1 6例,T2 20例,T3 17例,T4 11例;病理N分期:N0 46例,N1 6例,N2 2例。分析其尿流动力学资料及术后感染情况。结果 本组随访时间36~152个月,平均(65.46±18.25)个月,术后早期(3月内)无失访病例。29例患者尿流动力学检查结果:最大膀胱容量平均(500±71)ml,最大充盈压力(23±5)cmH 2O,最大尿流率(16±5)ml/s,最大尿流率时逼尿肌压力(79±11)ml/cmH 2O,残余尿量(50±44)ml。术后早期(3个月内)6例(11.1%)出现肾盂肾炎,其中3例尿培养为大肠埃希菌,1例为绿脓杆菌,另2例尿培养阴性;尿道狭窄1例。术后晚期(3个月后)15例(27.8%)出现有症状的泌尿道感染,其中8例为泌尿道感染反复发作,7人为肾盂肾炎;尿道狭窄5例,UVJ狭窄10例。3例患者术后尿道狭窄行尿道切开术,2例术后因残余尿增多行清洁导尿;7例肾盂肾炎患者中,4例发现输尿管新膀胱连接部狭窄,其中3例行开放输尿管膀胱再植术。结论 螺旋构型折叠回肠能达到术后新膀胱低压、高容量的要求,输尿管“插入式再植”后膀胱输尿管连接部狭窄发生率高可能是引起远期泌尿道感染患病率增加的原因。Objective To explore the urodynamic and urinary tract infection status of spiral configuration ileum orthotopic neobladder after radical cystectomy in patients with bladder cancer.Methods The clinical data of 54 cases with bladder cancer treated by radical cystectomy and spiral ileum orthotopic neobladder surgery were analyzed retrospectively,including 50 of urothelium carcinoma,2 of adenocarcinoma and 2 of squamous cell carcinoma.There is T1 in 6 cases,T2 in 20 cases,T3 in 17 cases and T1 in 11 cases,and N0 in 46 cases,N1 in 6 cases and N2 in 2 cases.Urodynamic data and postoperative infection were analyzed.Results The follow-up period ranged from 36 to 152 months with an average of (65.46±18.25) months.No cases were lost in the early stage (within 3 months) after operation.29 cases was performed urodynamic test: The maximum bladder volume was (500±71) ml,the maximum filling pressure was (23±5) cmH 2O,the maximum flow rate was (16±5) ml/s,the maximum detrusor pressure of urinary flow rate was (79±11) ml/cmH 2O,and the residual urine volume was (50±44) ml.Pyelonephritis were found in 6 cases (11.1%) in early stage (3 months) after the operation,and urinary culture showed 3 of escherichia coli infection,1 of pyocyanic infection and 2 of negative urinary bacteria culture.Urethral stricture was found in one case.In the late stage (3 months later),15 cases (27.8%) appeared symptomatic urinary tract infections,8 of which were recurrent urinary tract infections and 7 were pyelonephritis.There were 5 cases of urethral stricture and 10 cases of UVJ stricture.The urethrotomy was carried out in 3 patients of urethral stricture,clean urethral catheterization was performed in 2 cases due to increased residual urine.Four patients with pyelonephritis were found new ureteral bladder junction stricture,of which three cases underwent open ureteral bladder replantation.Conclusions The spiral configuration ileum can achieve the requirement of low pressure and high capacity after radical cystectomy.The surgical procedure of sp

关 键 词：回肠新膀胱 螺旋构型 尿流动力学 尿道感染 膀胱肿瘤 

分 类 号：R737.14[医药卫生—肿瘤]