膀胱全切除术治疗老年膀胱癌

目的 :探讨膀胱全切除术治疗老年膀胱癌的安全性。方法 :2 9例老年膀胱癌患者行膀胱全切除术 ,尿流改道采取直肠膀胱 10例 ,乙状结肠膀胱 9例 ,回肠膀胱 6例 ,输尿管皮肤造瘘术后 4例 ,同时行尿道切除术 5例。结果 :术后发生尿瘘 2例 ,粘连性肠梗阻 2例 ,出血 1例 ,死亡 2例。本组死亡率与同期老年膀胱全切除术患者死亡率相比 (1 37)差异无显著意义 ,P >0 0 5。结论 :膀胱全切除术治疗老年膀胱癌是一种可行的手术方法 ,降低死亡率的关键是做好围手期处理     

腹腔镜根治性膀胱切除+回肠原位新膀胱术疗效分析

目的:回顾分析腹腔镜下全膀胱切除+回肠原位新膀胱术的临床疗效与经验.方法:随访了2006年1月-2012年2月采用腹腔镜下根治性膀胱切除术+回肠原位新膀胱术治疗的87例患者,手术方法为腹腔镜下膀胱全切术+开放新膀胱构建及吻合,并对随访3年的临床数据进行总结分析.结果:大多数患者恢复良好,所有的新膀胱漏尿并发症均被有效处理;仅有1例患者因肠瘘行肠造口,3个月后行肠回纳;术后3年整体生存率为88.5％(77/87),无瘤生存率为92.2％ (71/77);整体控尿功能及肾功能保护方面取得良好效果.结论:腹腔镜下根治性膀胱全切+回肠原位新膀胱术,具有良好的控尿功能和较好的保肾功能,可以明显提高患者生活质量.     

Studer回肠新膀胱的手术改良探讨

目的:对Studer回肠新膀胱术进行技术改良并评价其临床效果.方法:采用根治性膀胱全切、改良Studer回肠新膀胱术治疗5例男性浸润性膀胱癌患者.结果:5例患者手术顺利.拔除尿管后4例患者恢复生理性排尿,1例不能自主排尿.随访6～12个月,4例患者昼夜控尿良好.5例患者静脉肾盂造影未见输尿管新膀胱吻合口狭窄及上尿路积水.结论:改良Studer回肠新膀胱术操作相对简单,手术并发症低,可以取得满意的临床效果.     

原位回肠代膀胱的临床应用体会

[目的]探索选择一种能为医患双方共同接受的代膀胱术。[方法]对12例膀胱癌病人行根治性切除术后施行原位回肠膀胱术,并进行跟踪随访。[结果]本组无1例出现永久性尿失禁及肾功能损害,亦无新膀胱颈口与尿道断端吻合口狭窄。[结论]原位回肠膀胱自控性强,容量大,生活质量好,是一种理想的代膀胱术。     

直肠癌前切除术后吻合口瘘24例临床分析

[目的]探讨直肠癌前切除术后发生吻合VI瘘的影响因素、预防及治疗措施。[方法]对直肠癌患者行前切除术后发生吻合VI瘘患者的临床资料进行回顾分析。[结果]556例直肠癌患者均行前切除术,发生吻合口瘘24例,其中行保守治疗8例（7例治愈,1例转手术治疗后治愈）;行末端回肠造瘘术11例,横结肠造瘘术5例,均治愈。单因素分析显示吻合口瘘的发生与患者性别、是否合并糖尿病、术前肠梗阻、肿瘤与肛缘距离、肿瘤的分期等因素有关（P〈O．05）,多因素分析显示术前肠梗阻、肿瘤分期、肿瘤与肛缘距离为吻合口瘘发生主要危险因素（P〈0．05）。[结论]充分的术前准备,精细的手术操作,正确的治疗措施,是减少吻合口瘘发生,减轻吻合口瘘的关键。     

改良全膀胱切除和原位新膀胱术重建下尿路功能

背景与目的:全膀胱切除原位新膀胱术是治疗浸润性膀胱癌最有效的手段.但由于手术繁杂、时间长、出血和并发症较多,以及相当一部分患者控尿不佳等缺点,我们对全膀胱切除和原位新膀胱术进行了反复改良,获得了比较满意的效果,本文报告我们的经验.方法:采用改良的全膀胱切除和原位新膀胱术治疗119例临床诊断为浸润性膀胱癌的患者.男性109例,女性10例.年龄33～78岁,平均55岁.统计手术时间、术中出血和输血量,对新膀胱功能、并发症、肿瘤控制和生存情况进行随访分析.结果:对全膀胱切除和原位新膀胱术一共进行了八处改良.从2000年1月至2007年2月用改良术治疗119例,无围手术期死亡.手术时间150～330 min,平均245 min.输血39例(32.8%).术后病理分期浅表性膀胱癌(T1N0M0) 9例,浸润性110例(其中T2N0M0 102例、T3aN0M0 3例、T3aN1M0 2例、T3bN1M0 2例,、T4N1M0 1 例).随访6～72个月,平均45个月,108例生存,10例因肿瘤死亡,1例非肿瘤原因死亡.术后白天控尿良好113例(95%),夜间控尿良好97例(81.5%).主要并发症有切口裂开5例,二次缝合后治愈;输尿管新膀胱吻合口漏1例,经再次手术作输尿管再植治愈;肠梗阻3例需住院处理.输尿管末端粘连引起肾积水8例,经内镜下切断粘连后积水消退.无肠瘘和新膀胱尿道吻合口瘘或狭窄,无膀胱输尿管返流.结论:全膀胱切除后采用改良原位新膀胱术重建下尿路功能,手术时间短、出血少和并发症少,新膀胱控尿和排尿满意,是目前全膀胱切除后最理想的下尿路重建方式.     

根治性全盆脏器切除术治疗局部晚期／复发性直肠癌的临床研究

目的：探讨根治性全盆脏器切除术治疗局部晚期／复发性直肠癌的效果。方法：对44例局部晚期／复发性直肠癌的临床、病理资料进行回顾性分析。结果：根治性全盆腔脏器切除术30例、姑息性切除术14例。结肠造瘘术39例,回肠代膀胱术21例,输尿管腹壁造瘘术23例。盆底腔隙采用膀胱脏层腹膜修复39例、双侧腹膜修复3例、带蒂大网膜填充1例、回肠末段填充1例。围手术期死亡率23％,总体并发症发生率50.0％。根治性和姑息性全盆脏器切除术后5年生存率分别为53.3％和0％。结论：根治性全盆腔器官切除术是提高局部晚期／复发性直肠癌病灶整块切除率、降低局部复发率、延长生存期的理想术式。     

32例老年左半结肠癌致急性肠梗阻的治疗体会

目的 探讨老年左半结肠癌致急性肠梗阻的治疗方法.方法 回顾性分析32例老年左半结肠癌致急性肠梗阻的临床资料.结果23例术前成功通过经肛插入型肠梗阻导管行结肠减压、灌洗去污后,20例施行了限期一期切除吻合术,术后无一例发生吻合口瘘;9例插管失败急诊手术者,6例施行了一期切除吻合术,术后发生吻合口瘘2例,其中1例于术后第...     

腹腔镜及开放根治性肾输尿管膀胱切除术治疗输尿管癌合并膀胱混合癌1例报告及文献回顾分析

目的：探讨腹腔镜和开放根治性肾输尿管膀胱切除术治疗输尿管癌合并膀胱混合癌患者的可行性和安全性。方法：回顾分析1例单侧输尿管癌并浸润性膀胱混合癌,腹腔镜下行根治性肾输尿管膀胱切除术及开放尿流改道手术患者的临床资料并进行随访分析。结果：术前经B超、CT、膀胱镜、输尿管镜和静脉肾盂造影等检查证实为左输尿管癌并浸润性多发膀胱癌,行腹腔镜肾输尿管膀胱切除术及开放尿道切除术和右侧输尿管皮肤造口术,手术时间480min,术中出血量约560ml,无输血。术后肠功能恢复时间为3d,下床活动时间4d。术后未出现并发症。术后病理结果为膀胱高级别泌尿上皮癌伴浸润性鳞状细胞癌侵及全层。左输尿管癌高级别泌尿上皮癌侵及全层。输尿管癌分期分级为T2N0M0,膀胱癌为T2N0M0。术后随访10月,患者无瘤生存至今。结论：单侧输尿管癌合并膀胱混合癌可行一期根治性肾输尿管膀胱切除术,腹腔镜下行该手术是可行及安全的。较开放手术创伤小,恢复快。膀胱混合癌很难早期确诊,为了使膀胱混合癌得到早期诊断和治疗,提高患者生存率,行膀胱镜检查时,应多位点取材。     

膀胱造瘘术后诊断膀胱癌1例报告

<正>膀胱癌是泌尿外科最常见的恶性肿瘤之一。膀胱造瘘后部分患者后期会出现慢性尿路感染、刺激性皮炎、瘘口周围漏尿、反复血尿、膀胱挛缩,甚至膀胱肿瘤等并发症。我院近期收治1例65岁膀胱造瘘术后4年诊断膀胱癌并行根治性膀胱切除+输尿管皮肤造口手术的患者,现报告如下。1 病例资料患者男性,65岁,因“膀胱造瘘管间断血尿伴周围漏尿半年”入院。既往14年前诊断脑动脉瘤破裂出血于华西医院行手术治疗。4年前诊断神经源性膀胱行耻骨上膀胱切开造瘘术。     

Orthotopic neobladder reconstruction after radical cystectomy in patients with a solitary functioning kidney: Clinical outcome and evaluation

ObjectiveTo evaluate, in a prospective study, the clinical outcome of orthotopic neobladder reconstruction after radical cystectomy in patients with a solitary functioning kidney at the time of surgery.Patients and methodsThis study included a total of 28 patients (25 males and three females) with muscle invasive bladder cancer and a solitary functioning kidney at the time of surgery who underwent radical cystectomy (anterior pelvic excentration for females) and urinary reconstruction using orthotopic neobladder at The National Cancer Institute, Cairo University between February 2004 and April 2009. The surgical procedures included ileocaecal neobladder in 19 patients, ileal neobladder (Studer) in five and sigmoid neobladder in four. All perioperative and long-term complications were recorded. The renal functions were evaluated using mainly serum creatinine level, abdominal ultrasonography and intravenous urography (IVU).ResultsThe mean age of patients was 51.4 years (range of 38–62 years) while the mean follow-up period was 41.4 months (range 18–62 months). Early complications included wound infections in five patients, urine leakage in six, abdominal dehiscence with deep venous thrombosis in two, intestinal obstruction and prolonged ileus in three. During the follow-up period, 21 renal units (75%) remained stable with normal serum creatinine level and normal radiological configuration of the kidney. The remaining seven patients (25%) developed varying degrees of renal deterioration either due to uretero-intestinal stricture in three patients (10.7%), who were all treated by open surgical revision of the anastomotic sites or due to stricture at the vesico-urethral anastomosis in four patients (14.3%) that had been successfully managed by endoscopic dilatation and internal urethrotomy with stabilization of renal function. Severe metabolic acidosis occurred in one patient while mild forms occurred in three. These four patients required sodium bicarbonate therapy and their metabolic status was normalized thereafter.ConclusionSelecting the type of urinary diversion is important in patients with a solitary functioning kidney after radical cystectomy. Orthotopic neobladder reconstruction is a good choice in properly selected patients and could provide comparatively satisfactory results. Accordingly, a solitary functioning kidney should not be regarded as a contraindication for neobladder reconstruction after radical cystectomy.     

Outcomes of urinary diversion after surgery for locally advanced or locally recurrent rectal cancer with complete cystectomy; ileal and colon conduit

IntroductionSurgery for locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) may require total pelvic exenteration with the need for urinary diversion. The aim of this study was to describe outcomes for ileal and colon conduits after surgery for LARC and LRRC.MethodsAll consecutive patients from two tertiary referral centers who underwent total pelvic exenteration for LARC or LRRC between 2000 and 2018 with cystectomy and urinary reconstruction using an ileal or colon conduit were retrospectively analyzed. Short- (≤30 days) and long-term (>30 days) complications were described for an ileal and colon conduit.Results259 patients with LARC (n = 131) and LRRC (n = 128) were included, of whom 214 patients received an ileal conduit and 45 patients a colon conduit. Anastomotic leakage of the ileo-ileal anastomosis occurred in 9 patients (4%) after performing an ileal conduit. Ileal conduit was associated with a higher rate of postoperative ileus (21% vs 7%, p = 0.024), but a lower proportion of wound infections than a colon conduit (14% vs 31%, p = 0.006). The latter did not remain significant in multivariate analysis. No difference was observed in the rate of uretero-enteric anastomotic leakage, urological complications, mortality rates, major complications (Clavien-Dindo≥3), or hospital stay between both groups.ConclusionPerforming a colon conduit in patients undergoing total pelvic exenteration for LARC or LRRC avoids the risks of ileo-ileal anastomotic leakage and may reduce the risk of a post-operative ileus. Besides, there are no other differences in outcome for ileal and colon conduits.     

Radical irradiation and misonidazole for T2 grade III and T3 bladder cancer: 2 year follow-up

Patients with T2 grade III and T3 bladder cancer were treated in a Phase II trial of radical irradiation plus Misonidazole (MISO). Forty Gy in 2 Gy fractions (5 per week) to the whole pelvis were followed by 12 Gy in 6 Gy fractions (1 per week) plus oral and intravesical MISO to a coned down volume. Twenty-two patients were treated and the results compared with historical controls. The cystoscopic complete tumor response between 6 and 12 months post therapy were 73 and 43%, respectively. The patient two year survival was 81 and 51%, respectively, and the patient 2 year survival with bladder preservation was 61 and 48%, respectively--4 patients in the MISO study having undergone salvage cystectomy. Complications that may be radiation related in the MISO study are wound sepsis after salvage cystectomy in 2 patients, rectal stenosis requiring colostomy 16 months after salvage cystectomy in 1 patient and the development of a contracted bladder in 1 patient with a history of prior extensive endoscopic therapy. No misonidazole neurotoxicity seen. These findings are being further evaluated in a prospective randomized trial.     

家族性腺瘤性息肉病18例报道

探讨家族性腺瘤性息肉病的临床特点和治疗问题。方法 对1984-2002年收治的18例病人进行回顾性分析。结果 有家族史者9例,癌变8例。手术方式:全结肠直肠切除8例,其中回肠造口2例,回肠储袋肛管吻合6例;结肠次全切除6例,其中回肠直肠吻合5例,升结肠肛管吻合1例;结肠部分切除2例;Miles术1例,结肠会阴造口1例。结论 认识该病的临床特点,根据息肉的分布特点和有无癌变等选择不同的手术方式,首选结直肠全切回肠储袋肛管吻合术。     

Orthotopic ileal neobladder reconstruction in a woman who developed squamous cell carcinoma of the urinary bladder after kidney transplantation

The case of a 62-year-old woman who developed squamous cell carcinoma of the bladder 16 years after a kidney transplant is reported here. After the transplant, immunosuppressive therapy was maintained with cyclosporin A (200 mg/day) and the patient's serum creatinine level was 0.9 mg/dL. She was diagnosed with squamous cell carcinoma of the bladder 16 years later and underwent radical cystectomy with an orthotopic ileal neobladder. The Studer technique was used and the afferent ileal loop was anastomosed to the graft ureter. The postoperative course was uneventful. At the 6-month follow-up visit, the patient showed no evidence of recurrence. Her serum creatinine level was 1.0 mg/dL. The patient was continent during the day and the night. This case shows that the construction of an orthotopic ileal neobladder after cystectomy is safe and feasible in kidney transplant recipients.     

腹腔镜根治性膀胱癌切除术后行回肠膀胱术和输尿管皮肤造口术的疗效比较

目的 比较腹腔镜根治性膀胱癌切除术后行回肠膀胱术和输尿管皮肤造口术的疗效.方法 选择行腹腔镜根治性膀胱癌切除术后患者90例,随机分为A组和B组,均45例.A组采取回肠膀胱术,B组采取输尿管皮肤造口术.比较2组手术时间、术中出血量以及术后住院时间、术后并发症、术后生存质量.观察2组患者的胃肠道功能恢复情况.结果 B组患者的手术时间、术中出血量及术后住院时间均明显低于A组(P＜0.01).2组术后尿路感染和肺感染的发生率差异无统计学意义(P＞0.05),B组的切口感染、肠梗阻发生率均明显低于A组,而漏尿发生率明显高于A组(P＜0.05).2组患者术后生理状况、社会/家庭状况、情感状况、功能状况评分比较无统计学差异(P＞0.05).B组胃肠功能恢复的优良率为44.44％,显著高于A组22.22％,差异有统计学意义(x2 =4.05,P＜0.05).结论 膀胱癌切除术后回肠膀胱术和输尿管皮肤造口术各有优、缺点,可根据患者个体情况选择合适的手术方式.     

经内镜肠梗阻导管治疗左半结直肠癌梗阻的临床应用

目的:探讨电子结肠镜引导下肠梗阻导管减压术治疗急性左半结直肠梗阻的临床疗效。方法:收集2006-06-2010-08我院57例肠梗阻患者分为试验组(33例)和对照组(24例);对照组给予常规治疗,试验组在电子结肠镜引导下置入肠梗阻导管减压4～5d,再行手术治疗。比较分析两组手术方式及并发症的差异。结果:试验组2例置管失败,32例获得肿瘤切除,肠管Ⅰ期吻合,1例单纯结肠造瘘。对照组20例行肿瘤切除,术中结肠灌洗Ⅰ期吻合,术后刀口感染6例,感染发生率为25%(6/24);4例行肿瘤切除,近段结肠造瘘,3个月后行Ⅱ期吻合。结论:结肠镜引导下肠梗阻导管减压术治疗急性左半结直肠恶性梗阻安全且有效。     

低位直肠癌保肛术后阴道瘘治疗体会

目的探讨低位直肠癌保肛术后阴道瘘治疗预防措施。方法3例直肠阴道瘘患者行结肠造瘘术，并对一例典型病例的治疗效果进行分析。结果经过结肠造口术、阴道瘘口修补术、结肠造瘘口还纳术，3例均已治愈。结论对直肠阴道瘘患者行规范治疗，效果满意。     

The 'pitcher pot' ileal neobladder: early experiences

OBJECTIVE: To analyse initial results of newly designed ileal neobladder-a modification of Studer neobladder METHODS: Twenty-four patients with urinary bladder cancer underwent radical cystoprostatectomy from February 2005 to March 2006. Twenty-one of them had urinary diversion using ileal neobladder in spherical configuration with ileal neourethra (giving the shape of an inverted Indian earthenware container called a 'pitcher pot') to circumvent the problem of short mesentery and construct a low-pressure spherical ileal neobladder. RESULTS: Early post-operative complications occurred in 42% of patients. Late complications occurred in 23% of patients. Most of these complications were minor, mainly as a result of wound infection, urine leak or urinary tract infections and were managed conservatively. No early post-operative mortality was observed. Daytime continence was achieved in 100% of patients who completed the 1 year follow-up. Night-time continence was variable as it depended on timed voiding--75% of patients achieved nocturnal continence by 1 year. The functional neobladder capacity was 426 ml. The mean post-operative residual volume was 36 ml. Three patients required cystoscopic mucus evacuation and catheterization. None of them required clean intermittent catheterization. No significant metabolic disturbance occurred in any patient. CONCLUSIONS: Length of mesentery remains one of the factors in deciding the segment of intestine to be taken for neobladder. Ileal neourethra gives about 2-3 cm extra length to perform tensionless anastomosis, which is a key factor in the smooth recovery after such major surgery and also maintains optimum urodynamic features of neobladder.