改良根治性膀胱全切原位回肠新膀胱术治疗男性膀胱癌的临床研究

目的探讨改良根治性膀胱全切原位回肠新膀胱术治疗膀胱癌的临床应用价值。方法 45例膀胱癌患者随机分为对照组（20例）与改良组（25例）,其中对照组行经典根治性膀胱全切原位回肠新膀胱术,改良组行改良根治性膀胱全切原位回肠新膀胱术,术中注意对膜部尿道括约肌、神经血管束加以保留。结果①改良组手术时间短于对照组,为（265.1±27.8）min vs.（302.4±46.5）min,出血量少于对照组,为（403.9±156.2）ml vs.（485.3±121.6）ml,P〈0.05。②改良组术后发生并发症12例（48%）,明显低于对照组的18例（90%）,P〈0.01。③两组间最大膀胱容量和充盈期膀胱内压无明显差异（P〉0.05）,但改良组残余尿量少于对照组,为（22.9±7.6）ml vs.（45.3±12.4）ml,最大尿流率高于对照组,分别为（18.3±3.5）ml/s vs.（14.9±3.2）ml/s（P〈0.01或P〈0.05）。④改良组患者勃起功能保留率明显高于对照组（82.4%vs.46.7%）,P〈0.05。⑤改良组与对照组间2年生存率（87.5%vs.78.6%）、5年生存率（66.7%vs.71.4%）和平均生存时间（52.6±8.2）个月vs.（56.9±7.8）个月比较差异无统计学意义（P〉0.05）。结论改良根治性膀胱全切原位回肠新膀胱术不仅可达到肿瘤根治目的,而且可明显改善患者储尿、排尿、控尿功能,有效保护患者阴茎勃起功能。

Clinical Study of the Modified Radical Cystectomy with Orthotopic Ileal Neobladder for Male Bladder Cancer Patients

Objective To explore the clinical effects of the modified radical cystectomy with orthotopic ileal neobladder in the treatment of male bladder cancer.Method 45 men with bladder cancer were randomly divided into control group(20 cases) which underwent classical operation and modified group(25 cases) which underwent modified cystectomy with reservation of the compressor urethrae and the neurovascular bundle.Results ①There were significant differences between the modified and control group in the mean operative time and the mean blood loss(P<0.05).②The complication rate of the modified group was lower than the control group,which was 48%(12/25) vs.90%(18/20)(P<0.05).③ There were significant differences in post voiding volumes and Qmax between the two groups(P<0.01 or P<0.05),but no difference in the volumes of neobladder and intravesical pressure(P>0.05).④Compared with the control group,the erectile function was effectively preserved in the modified group(82.4% vs.46.7%)(P<0.05).⑤ There was no difference between the modified and the control group in the 2-year survival rate,5-year survival rate and average survival time(P>0.05). Conclusion The modified radical cystectomy with orthotopic ileal neobladde could not only radically cure the bladder cancer,but also improve the continence and voiding function of the neobladder and preserve the erectile function.