摘要
目的 评价Studer原位尿流改道治疗女性浸润性膀胱癌的临床效果。方法 回顾性分析1998年5月至2005年2月20例女性膀胱全切、Studer原位尿流改道患者的资料。患者年龄48～65岁，平均56岁。膀胱移行细胞癌19例、腺癌1例。术中取回肠袢约65cm，其中近端10～12cm作为抗返流输入道，远端53-55cmU形折返缝合成球形肠膀胱。结果 手术时间4．5～8．0h，平均6．0h。输血量300-600ml，平均465ml。随访4～84个月，平均25个月。围手术期患者无死亡。早期并发症有黏液阻塞尿道6例、漏尿1例、腹泻4例、肺部感染2例。术后2年肠膀胱内结石1例，于腔镜下取出。术后肠膀胱容量约140ml，术后3个月平均390ml，1年后平均500ml。患者均利用腹压排尿，剩余尿0～49ml，平均19m1。白天排尿4～6次，平均4．5次，夜间0～4次，平均2次。白天控尿良好，夜间尿失禁1例，需2块尿垫。术后1年尿动力学检查13例：充盈期膀胱压力19～28cmH2O，最大尿流率12～19ml／s。17例术后3个月尿路造影示肠膀胱形态良好，无输尿管返流及上尿路扩张，3例患者出现轻微返流，未引起上尿路扩张，B超测定肾皮质厚度无变化。肾功能和血电解质结果正常，无盆腔和尿道肿瘤复发。结论 Studer原位尿流改道治疗女性浸润性膀胱癌患者并发症少，排尿和控尿功能满意。
Objective To evaluate the functional outcome of Studer ileal neobladder in women. Methods From May 1998 to February 2005,20 female patients with bladder cancer received Studer＇s ileal neobladder. Pathology report showed transitional cell carcinoma in 19 cases,bladder adenocarcinoma in 1 case. The orthotopic neobladder was created by using 65 cm of distal ileum, with 10- 12 cm being used to construct the afferent tubular limb. All data were analyzed retrospectively. Results The mean （range） operation time was 6.0（4.5-8.0）h, and mean（range） blood transfusion was 465 （300-600）ml. After a follow-up with 4 to 84 months （mean 25 months） , there was no perioperative deaths. Early complications included mucus obstruction （6 cases）, urine leakage（ 1 cases）, diarrhea （4 cases）, pneumonia （2 cases）. A neobladder calculus was found in 1 patient 2 years after surgery, which was treated by endoscopic litholapaxy. The average functional capacity of the neobladder was 140 ml in the immediate postoperative period, a median functional capacity of 390 ml was reached at 3 months and 500 ml at 12 months. All patients reported excellent day continence and could void spontaneously by abdominal pressure. One patient had nocturnal incontinence with using 2 pads at night. Patients urinated 4.5（4-6）times during the day and 2（0-4） times at night. Thirteen patients had good urodynamic outcome at 1 year after surgery： the maximum filling pressure within the pouch ranged 19 -28 cm H2O, maximum flow rate ranged 12-19 ml/s. Seventeen patients showed normal upper tract and had a normal cystogram. Mild reflux was observed in 3 patients, who showed no evidence of upper tract hydronephrosis. Changes in parenchymal thickness were insignificant, and no one suffered from recurrence of urethral or neobladder during followup. Renal function and biochemistry test were normal in all patients. Conclusions Studer ileal neobladder in women could offer a sufficient protection of the upper urinary tract with a low
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2007年第4期264-267,共4页
Chinese Journal of Urology
关键词
膀胱肿瘤
尿流改道
女性
Bladder neoplasms
Urinary diversion
Women
