原位回盲肠新膀胱术的初步研究  

Pilot study of orthotopic ileocecal neobladder after retrograde radical cystectomy

作　　者：胡伟 高闫尧 付强 孙振业 夏明远 贺焕章 李霞 李岐 简伟明 王禾 Hu Wei;Gao Yanyao;Fu Qiang;Sun Zhenye;Xia Mingyuan;He Huanzhang;Li Xia;Li Qi;Jian Weiming;Wang He(Department of Urology,Tangdu Hospital,Air Force Medical University,Shaanxi Xi'an 710038,China;Department of Urology,No.967 Hospital of PLA,Liaoning Dalian 116012,China;Department of Urology,Electric Power Center Hospital,Shaanxi Xi'an 710000,China;Department of Biochemistry and Molecular Biology,Air Force Medical University,Shaanxi Xi'an 710032,China)

机构地区：[1]空军军医大学第二附属医院泌尿外科,陕西西安710038 [2]解放军第967医院,辽宁大连116012 [3]西安电力中心医院,陕西西安710000 [4]空军军医大学生物化学与分子生物学教研室,陕西西安710032

出　　处：《现代肿瘤医学》2020年第18期3203-3206,共4页Journal of Modern Oncology

基　　金：陕西省重点研发计划项目(编号:2020SF-124);唐都医院创新发展基金面上项目(编号:2018LCYJ007)。

摘　　要：目的:探讨逆行全膀胱切除术后原位回盲肠新膀胱术的手术方式、近期疗效和尿流动力学特点。方法:回顾性分析2018年11月至2019年8月我科收治并行原位回盲肠新膀胱术膀胱癌患者4例,所有患者先行腹膜外逆行根治性全膀胱切除,截取回盲肠构建新膀胱,再将新膀胱与尿道吻合重建尿流通道。术后定期复查尿动力、肾功能、彩超等检查。结果:本组患者随访6~16个月,术后初期患者均有不同程度溢尿现象,3个月后逐步恢复并能良好控尿。1例术后出现尿道吻合口轻度狭窄并输尿管返流。新膀胱最大储尿容量(401.7±53.0)ml,储尿期膀胱内压(19.0±5.7)cmH2O,尿道闭合压(53.6±9.4)cmH2O,储尿期膀胱内压明显小于尿道闭合压,最大尿流率(18.7±1.5)ml/s,平均残余尿量(21.3±4.4)ml。结论:全膀胱切除术后原位回盲肠新膀胱术具有储尿囊容量大、压力低、可控性好、操作简单的优点,是一种较理想的尿流改道方式。Objective:To evaluate the operative procedure,short-term complications and urodynamics of orthotopic ileocecal neobladder after retrograde radical cystectomy.Methods:From November 2018 to August 2019,4 cases of patients with bladder cancer underwent retrograde radical cystectomy and subsequent neobladder reconstruction in our department.All patients underwent extraperitoneal retrograde radical cystectomy,then we used the ileocecum to reconstruct a new bladder and anastomosed the cecal end of the new bladder to the urethra.Urodynamics,renal function,urologic ultrasonography and other routine examinations were regularly performed after surgery.Results:The patients in this group were followed up for 6~16 months.In the early postoperative period,the patients all suffered from varying degrees of urinary incontinence,and 3 months later they were gradually able to controlled urination well.One patient had mild urethral anastomotic stricture and ureteral reflux.During the filling phase,evaluation of the patients revealed a maximum neobladder capacity of(401.7±53.0)ml,mean filling pressure of(19.0±5.7)cmH2O and mean urethral closure pressure of(53.6±9.4)cmH2O,and that the intravesical pressure was significantly less than the urethral pressure.During voiding,the maximum flow rate was(18.7±1.5)ml/s,with an average postvoid residual volume(21.3±4.4)ml.Conclusion:Orthotopic ileocecal neobladder following radical cystectomy is an ideal urinary diversion with the advantages of large reservoir capacity,low pressure,good controllability,and simple operation.

关 键 词：膀胱肿瘤 尿流改道 原位回盲肠新膀胱 尿流动力学 

分 类 号：R737.14[医药卫生—肿瘤]