摘要
目的探讨膀胱癌行膀胱全切原位回肠膀胱术后，新膀胱对上尿路功能的影响。方法评估2006年3月-2010年6月陕西省核工业二一五医院泌尿外科收治的28例肌层浸润性膀胱尿路上皮癌行膀胱全切W形原位回肠代膀胱患者的上尿路功能，所有病例随访2年以上。评估项目包括肌酐测定、泌尿系B超测定膀胱残余尿量及肾积水量、膀胱造影明确有无尿液反流。结果术后4周拔除导尿管之前行膀胱造影检查，未发现明显造影剂外溢，术后3个月轻度肾积水8例（28．6％），其中2例（7．1％）术前即合并有肾积水,χ^2=0．49（P〉0．05），差异无统计学意义。术后2年轻度肾积水5例（17．9％），与术前比较,χ^2=0．22（P〉0．05）差异无统计学意义。术前血肌酐（72．92±14．58）mmoL／L，术后3个月血肌酐（83．42±15．18）mmol／L，t=-6．43（P〈0．05），手术前后血肌酐均值均在正常值范围，术后2年血肌酐（82．50±14．39）mmoL／L，与术前比较，t=-4．67（P〈0．05），但均在正常范围，无临床意义。术后3个月膀胱容量（160±23）mL，残余尿量（58．7±9．7）mL，术后2年膀胱容量（430±21）mL，残余尿量（61．3±37．1）mL，t=-0．37（P〉0．05），差异无统计学意义。结论原位W型回肠膀胱可作为膀胱全切术后较为理想的待膀胱术式，对上尿路功能影响较轻。
Objective To explore bladder carcinoma cystectomy and orthotopic ileal neobladder postoperative, the impact of new bladder on upper urinary function. Methods Twenty- eight patients with muscle invasive bladder urothelial carcinoma undergoing eystectomy W-shaped orthotopie ileal neobladder in Depart- ment of Urology of the Nuclear Industry 215 Hospital of Shaanxi Province （ Mar. 2006 - Jun. 2010） were investigated. All patients were followed for over 2 years. Assessment items included creatinine determination, urinary B-Ultrasound determination of the amount of residual urine volume and hydronephrotic cystography.Results Four weeks after the operations, all patients were removed bladder catheter angiography and found no obvious contrast extravasation. After 3 months mild hydrouephrosis was found in 8 cases （ 28.6% ） , including 2 cases （7.1% ） before surgery associated with hydronephrosis, the difference being not statistically significant（χ^2 = 0. 49, P 〉 0.05 ）. The mild hydronephrosis was found in 5 cases （ 17.9% ） 2 years postoperation, whithout statistically significant difference compared with preoperation （χ^2= 0. 22, P 〉 0. 05）.Preoperative serum creatinine was （72.92 ± 14.58 ） mmol/L, while 3 months after surgery serum creatinine was （83.42 ± 15.18 ） mmol/L（ t = - 6.43,P 〈 0.05 ）. Preoperative and postoperative serum creatinine was within the normal range. Two years after surgery serum creatinine was （82.50 -± 14.39） mmol/L, with significant difference compared with that of preoperation （ t = - 4.67, P 〈 0.05 ）, but were in the normal range, no clinical significance, the postoperative 3 months bladder capacity （ 160 ± 23） mL, while 2 years later bladder capacity residual urine volume of （58.7 -± 9.7） mL and （430 ± 21 ） mL, residual urine volume （61.3 ± 37.1） mL（t = -0. 37,P 〉 0.05）. Conclusion Orthotopic ileal bladder ideal substitute for postoperative cystectomy with less impact on the upper urinary tract function.
出处
《国际外科学杂志》
2012年第10期660-662,共3页
International Journal of Surgery
关键词
尿道改流术
膀胱肿瘤
上尿路
功能恢复
Urinary diversion
Urinary bladder neoplasms
Upper urinary
Recovery of function
