改良Hautmann原位回肠膀胱手术初步经验(附12例报告)  

Preliminary experience of modified Hautmann orthotopic ileal bladder surgery(report of 12 cases)

作　　者：陈瑞宝 梅江 尹懿盛 李书荣 占立君 梁昌 覃振亮 卢帅 詹鹰 曾晓勇[1] CHEN Ruibao;MEI Jiang;YIN Yisheng;LI Shurong;ZHAN Lijun;LIANG Chang;QIN Zhenliang;LU Shuai;ZHAN Ying;ZENG Xiaoyong(Department of Urology,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院泌尿外科,武汉430030

出　　处：《现代泌尿生殖肿瘤杂志》2025年第1期19-22,共4页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的总结改良Hautmann原位回肠膀胱手术的经验,评估手术的可行性、安全性及术后恢复情况。方法回顾性收集并整理2018年1月1日至2023年1月1日华中科技大学同济医学院附属同济医院泌尿外科收治的12例行改良Hautmann原位回肠膀胱手术的患者临床资料,并对手术要点,围手术期管理及术后随访情况进行分析总结。结果本研究纳入11例男性膀胱癌患者和1例女性膀胱挛缩患者,平均年龄58.1岁。11例男性患者术前均行经尿道膀胱肿瘤电切术,其中10例患者病检证实为高级别尿路上皮癌,1例患者为原位癌;1例女性膀胱挛缩患者双侧输尿管末端存在梗阻。11例男性患者常规行腹腔镜膀胱根治性切除术加盆腔淋巴结清扫,再行改良Hautmann原位回肠膀胱手术,1例女性患者直接行改良Hautmann原位回肠膀胱手术。手术时间为180~380 min,术中出血量为200~800 ml,术后住院时间8~18 d,围手术期无出血、尿瘘或肠瘘等严重并发症发生,3例患者出现切口脂肪液化,经清创缝合后痊愈。随访时间为4~52个月,2例患者发生不全性肠梗阻,1例患者术后出现尿道狭窄伴尿潴留,均经有效治疗后好转。其余患者恢复良好,术后3个月后均能控尿,并借助腹压自主排尿。结论改良Hautmann原位回肠膀胱手术并发症少,患者术后生活质量高,证明其在膀胱癌及膀胱挛缩患者中的可行性和安全性。Objective summarize the experience and key points of modified Hautmann orthotopic ileal bladder surgery,and analyze its feasibility and safety.Methods The clinical data of 12 patients with modified Hautmann orthotopic ileal bladder surgery admitted to the urology department of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 1st,2018 to January 1st,2023 were collected and summarized.The key points of surgery,perioperative management,and postoperative follow-up data were analyzed and summarized.Results Eleven men in this group were all bladder cancer patients,while 1 woman was bladder contracture patients.The age ranged from 44.1 to 69.5,with an average age of 58.1.All male patients underwent transurethral resection of bladder tumor before surgery,Ten patients were diagnosed as high-grade urothelial carcinoma by pathological examination,and 1 patient was diagnosed as carcinoma in situ.A female patient with bladder contracture had obstruction at the ends of both ureters.All male patients underwent laparoscopic radical cystectomy plus pelvic lymph node dissection,followed by modified Hautmann orthotopic ileal bladder surgery,while one female patient underwent modified Hautmann orthotopic ileal bladder surgery directly.The operation time was 180-380 min.The intraoperative bleeding volume was 200-800 ml,and the postoperative hospital stay was 8-18 days.There were no serious complications such as bleeding,urinary fistula,intestinal fistula,etc.during the perioperative period.Three patients had incision fat liquefaction,and recovered after debridement and suture.Follow-up time was 4-52 months.Two patients developed incomplete intestinal obstruction 1 month and 2 months after discharge,respectively,and their condition improved after symptomatic treatment in hospital.One patient developed urethral stricture with urinary rete ntion 3 months after operation,and improved after internal urethrotomy.The rest of the patients recovered well.After postoperative 3 months,they were a

关 键 词：膀胱癌 膀胱挛缩 原位回肠膀胱 

分 类 号：R73[医药卫生—肿瘤]