T型原位回肠新膀胱:尿动力学与上尿路功能初步评价

目的 评价T型原位回肠新膀胱尿动力学特征及对上尿路功能的影响.方法 2004年6月至2009年9月,90例T2a～T4a膀胱肿瘤患者接受根治性膀胱切除加T型原位回肠新膀胱重建术,采用肌酐测定、超声、膀胱造影、静脉尿路影或增强CT等方法进行上尿路功能的检查,对患者进行尿控情况的随访与尿动力学评价.结果 术后3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,4例(4.4%)输入袢显示清楚,但未见输尿管显示,其他均未见反流.上尿路超声、静脉尿路造影或CT检查,提示18例(20.0%)术后45 d内出现双侧肾盂及输尿管的暂时性轻度扩张,其中1例(1.1%)出现术后一过性肾功能不全,肌酐最高达57 mg/L,但在随访过程中肾盂输尿管恢复正常形态;4例(4.4%)术后3年出现双侧肾盂输尿管轻度扩张,但肾功能保持正常;其他患者血尿素氮、肌酐均在正常范围之内.日间94.4%(85/90)患者能完全控尿,5.6%(5/90)控尿满意,满意率达100%;夜间41.1%(37/90)患者完全控尿,41.1%(37/90)控尿满意,17.8%(16/90)控尿不满意,满意率达82.2%.尿动力学结果显示,平均灌注末压力为(16±10)cm H2O(1 cm H2O=0.098 kPa),最大膀胱容量为(316±96)ml;排尿呈腹压排尿模式,最高压力为(87±25)cm H2O,平均最大尿流率为(17±10)ml/s,残余尿量为(33±29)ml.结论 T型原位新膀胱输入袢的抗反流效果令人满意,充分保护了上尿路功能;新膀胱具有良好顺应性,患者控尿能力、尿流率及残余尿量也令人满意.

Orthotopic T pouch ileal neobladder: evaluations of urodynamics and upper urinary tract functions

Objective To evaluate the urodynamics and functions of upper urinary tract in a substitute of orthotopic T pouch ileal bladder. Methods From June 2004 through September 2009, 90 patients underwent the construction of an orthotopic T pouch ileal neobladder after radical cystectomy for muscle-invasive bladder cancer. The radiographic or ultrasound evaluation of upper urinary tract,determination of renal functions and urodynamic evaluation of T pouch ileal neobladder were performed by data analysis. Results Renal function as determined by serum creatinine remained in a normal range in all patients. Temporary dilation of renal pelvic and ureter was observed in 18 patients (20. 0% ) at Day 45 postoperation and then disappeared spontaneously in the late follow-up. A slight dilation of collecting system was found in other 4 patients (4. 4% ), but there was no negative impact on renal function. Reflux into afferent limb of neobladder was observed in 4 patients (4. 4% ) by cystography. Excellent daytime and nighttime continence was reported in 100% and 82.2% of evaluated patients respectively. The urodynamic assessment showed a mean capacity of (316 ±96) ml with a mean intra-bladder pressure of( 16 ± 10) cm H2O. These evaluated patients voided with a mean maximum intra-bladder pressure of(87 ± 25)cm H2O, a mean maximum flow rate of( 17 ± 10) ml/s and a mean residual urine of( 33 ± 29 ) ml. Conclusion With an intermediate follow-up, the functional results of T pouch ileal neobladder are encouraging with an excellent capacity and compliance, successful daytime and nighttime continence and anti-reflux mechanism.