原位W形回肠膀胱的尿动力学分析

目的:分析原位W形回肠膀胱的尿控效果。方法:对15例全膀胱切除原位W形回肠膀胱患者行尿动力学检查,测定尿流率、残余尿、储尿期回肠膀胱的顺应性、稳定性、回肠膀胱感觉、回肠膀胱容量及排尿期回肠膀胱收缩力。结果:本组患者15例,随访6~24个月,平均17个月。15例患者白天完全可控,14例患者夜间完全可控,溢尿1例。最大尿流率5.3~23.5 mL/s,平均14.6 mL/s。残余尿0~115 mL,平均45.5 mL。顺应性30~35 mL/cm H2O,平均33.5 mL/cm H2O。储尿期回肠膀胱较少出现无抑制性收缩,压力0~15 cmH2O,平均11.2 cmH2O。回肠膀胱感觉减退,无明显最初排尿感、正常排尿感。回肠膀胱容量为270~650 mL,平均405.7 mL。回肠膀胱内压力10.37~32.60 cmH2O(1cmH2O=0.098 kPa),平均21.65 cmH2O。排尿期均为腹压协助排尿。结论:原位W形回肠膀胱储尿囊压力低、控制排尿满意,是一种理想的尿流分流手术。

Urodynamic analysis of W-shaped orthotopic ileal neo-bladder

Objective： To analyze the continence results of the W-shaped orthotopic ileal neo-bladder.Methods： Urodynamic studies were carried out in 15 patients after radical cycestomy and W-shaped orthotopic ileal neo-bladder operation.The continence status,maximum urinary flow rate,postvoid residual,compliance,stability,sensation,capacity,voiding cystometry were observed in 15 patients.Results： The patients were followed up for a mean of 17 months（6-24 months）.All were completely under control during the day and 14 patients at the night.Only 1 patients had nocturnal incontinence.The mean maximum urinary flow rate was 14.6 mL/s （5.3-23.5） mL/s].The mean postvoid residual was 45.5 mL（0-115）mL].The mean compliance was 33.5 mL/cmH2O （30-35） mL/cmH2O].The mean capacity was 405.7 mL（270-650）mL].The mean pressure of filling phase was 21.65 cmH2O（10.37-32.60） cmH2O]（1 cmH2O=0.098 KPa）.The neo-bladder stability was in good condition,but the sensationg and contraction was decreased.Conclusion： W-shaped orthotopic ileal neo-bladder shows good continence results,exerts low pressure in the pouch and is highly recommended.