胃代膀胱术远期疗效观察

目的 探讨胃代膀胱术的远期疗效。方法 对1991年5月至2003年10月30例胃代膀胱术患者的临床资料进行统计分析。其中膀胱肿瘤28例，结核性膀胱挛缩2例。结果 随访8～13年，平均10年。30例全身健康情况良好，日间排尿满意，3例偶有夜间尿失禁。1例术后19个月发生代膀胱穿孔，经抗酸和手术治疗痊愈。30例肾功能正常，无电解质紊乱；24例排尿前后胃泌素及尿液pH检查正常；4例有无症状菌尿。13例代膀胱黏膜活检为慢性炎症，壁细胞减少；9例免疫组化检查G细胞较正常减少。尿动力学检查代膀胱容量及顺应性正常，排尿期贮尿囊压力低于正常。10例行排尿期膀胱造影无输尿管返流，5例B超示肾集合系统轻度扩张。1例低压胃膀胱成形术，1例胃与后尿道逆蠕动吻合，剩余尿分别为150ml和250ml。1例出现血尿尿痛综合征，经抗酸及碱化尿液治疗后缓解。结论 胃代膀胱术远期疗效满意，是一种较好的尿流改道方法。

Gastrocystoplasty :long term clinical experience

Objective To evaluate the long-term effects of gastrocystoplasty. Methods The clinical data of 30 cases of gastrocystoplasty were retrospectively analyzed.Of them,28 cases had bladder tumor and 2 had tuberculous bladder contracture. Results All the 30 cases were followed up for 8-13 years (mean,10 years).All of them were in good condition with excellent daytime urination;only 3 cases had occasional incontinence at night.One case had perforation of the neobladder at 19 months after operation and was cured by antacid and surgical treatment.The renal function and blood electrolytes were all within the normal range.The serum gastrin and urine pH were normal before and after urination in 24 cases;and asymptomatic bacteriuria occurred in 4 cases.Biopsies of gastric mucosa of the neobladder revealed chronic inflammation and a decrease of parietal cells in 13 cases.On immunohistochemical examination the antral G-cell density was less than normal in 9 cases.Urodynamic study showed that the neobladder volume and compliance were normal.The gastric reservoirs pressure during urination were lower than normal level. Cystography showed no ureteral urine reflux during urination in 10 cases.B-ultrasound showed mild dilation of collecting system of kidney in 5 cases.More residual urine was observed in 2 cases (100 ml and 250 ml,respectively),one of whom had low-pressure gastrocystoplasty and one had anastomosis of stomach and posterior urethra with retroperistalsis.One case experienced hematuria-urodynia syndrome,which was relieved by antacid and urine-alkalizing treatment. Conclusions The long-term effects of gastrocystoplasty were satisfactory and this surgical procedure is a better option for urinary diversion.