乙状结肠新膀胱术治疗膀胱癌11例疗效观察

目的观察膀胱全切术后乙状结肠新膀胱术治疗膀胱癌的效果。方法选择11例男性膀胱癌患者。根治性全膀胱切除,保留前列腺远端包膜0.5 cm。游离一段约20 cm的带系膜乙状结肠,恢复乙状结肠的连续性。将游离的结肠排为U形,于肠系膜对侧缘纵行剖开肠管,用2-0可吸收线缝合相邻肠瓣成囊状。于新膀胱上部两侧后壁各切一小口,将输尿管拉进新膀胱约1.0 cm,把输尿管浆肌层缝于新膀胱黏膜上,在新膀胱外缝合浆肌层包埋输尿管约1.5 cm。下部切开与尿道残端吻合,输尿管放置的支架管从新膀胱前壁穿出引至皮外,行新膀胱造瘘。结果 11例患者手术顺利,手术总耗时平均240(210～300)min。术中输血平均800(600～1 200)ml。平均储尿囊容量370(230～450)ml,残余尿量<30 ml。双侧肾积水7例,6个月后肾积水稳定,肾功能正常,输尿管反流2例。1例白天排尿不可控;5例夜间有尿失禁,术后3～6个月除2例偶有夜间尿失禁外其他病例排尿情况均得到改善。无代谢性酸中毒及黏液堵塞尿道。1例出现尿道狭窄,行尿道扩张治愈;1例出现肠梗阻;1例死于非原发疾病。结论乙状结肠新膀胱术手术操作相对简单,术后并发症少,原位自主排尿,尿液可控性高,具有临床推广应用价值。

Sigmoid neobladder treatment for 11 cases bladder cancer

Objective To observe the effect of sigmoid neobladder on the bladder cancer after total cystectomy.Methods Eleven cases of male patients with bladder cancer were observed.Radical cystectomy was executed with remote prostatic capsule 0.5 cm reserved.Mesenteric sigmoid 20 cm was freed,and the continuity of them was restored.Freed colon was ranked as the U-shaped,the intestine was opened in the opposite of the mesentery edge,and adjacent intestinal valve was sutured into the cystic form with 2-0 absorbable sutures.In both sides of the posterio-upper neobladder,a small hole was cut,respectively.The ureters were pulled into the new bladder about 1.0 cm long and were embedded in the lined bladder about 1.5 cm long.The lower part was incised and coincided with urethral stump,ureteral stent from anterior wall of the new bladder was pulled out to the skin,then cystostomy was made.Results The operation of 11 cases was uneventful,and the average operation time was 240 mins(210~300 min).Blood of average 800 ml(600~1 200 m1) was transfused.Average capacity of urinary reservoir was 370 ml(230~450 ml),and residual urine volume <30 ml.Bilateral hydronephrosis occurred in 7 cases,hydronephrosis was stable and renal function was normal after 6 months,and ureteral reflux occurred in 2 cases.Controllable urination occurred in 10 cases during the day,and uncontrollable urination occured in 1 case in daytime.Incontinence occurred in 5 cases at nighttime.Occasional urinary incontinence occurred in 2 cases at nighttime,and voiding was improved in others 3~6 months later.Metabolic acidosis and mucus blockage in the urethra were not observed.One case with airway stenosis was cured by expanding the urethra.Intestinal obstruction occured in 1 case.And 1 case died of non-indigenous diseases.Conclusion Sigmoid neobladder surgery is a relatively simple operation,which possesses the merits of less postoperative complications,self-voiding urine controllability in situ and the value of clinical application..