膀胱全切、Roux—y乙状结肠新膀胱术在女性膀胱癌治疗中的应用

目的：评价膀胱全切、Roux-Y乙状结肠新膀胱尿流改道术治疗女性浸润性膀胱癌的临床效果。方法：采用膀胱全切、Roux—Y乙状结肠新膀胱术治疗女性膀胱癌患者12例。术中取直肠腹膜反折以上20cm处切断乙状结肠,近端与直肠在腹膜反折上行乙状结肠-直肠Y式端侧吻合,远端去管化后,构建一球形新膀胱。结果：随访3—96个月,平均36个月。未见肿瘤复发。术后新膀胱容量约300ml,术后3个月平均405ml,1年后平均456ml。无尿失禁发生。术后尿动力学检查,充盈期膀胱压力（39．2±10．8）cmH2O、最大尿流率（34．7±8．9）ml／s,排泄后残留尿量是0ml。7例术后3年行尿路造影示新膀胱形态良好,无输尿管返流及上尿路扩张。结论：Roux—Y乙状结肠新膀胱尿流改道术治疗女性浸润性膀胱癌患者疗效好,并发症少,肿瘤复发率低,术后排尿和控尿功能满意。     

全去带乙状结肠原位可控膀胱术

目的：探讨一种全膀胱切除术尿道改道方法。方法：对6例全膀胱切除患者行去带乙状结肠原位可控膀胱术。结果：随访2－18月，平均12个月，贮尿囊中平均容量380ml，内压力1．86－3．93kpa，平均2．45kpa恢复完全自控排尿，无输尿管返流，血电解质和肾功能正常。结论：全去带乙状结肠原位可控膀胱术疗效可靠，术后患者生活质量高，原位自控排尿良好，并发症少，是一种理想的尿路分流术。     

全去带乙状结肠原位可控膀胱术

目的探讨一种全膀胱切除术尿道改道方法.方法对6例全膀胱切除患者行去带乙状结肠原位可控膀胱术.结果随访2～18月,平均12个月,贮尿囊中平均容量380ml,内压力1.86～3.93kpa,平均2.45Kpa恢复完全自控排尿,无输尿管返流,血电解质和肾功能正常.结论全去带乙状结肠原位可控膀胱术疗效可靠,术后患者生活质量高,原位自控排尿良好,并发症少,是一种理想的尿路分流术.     

功能训练对根治性膀胱全切后原位乙状结肠代膀胱患者的效果

目的:对根治性的膀胱全切除原位乙状结肠代膀胱患者采取系统性膀胱功能训练的临床效果和尿流动力学进行分析.方法:分析中国医科大学盛京医院2014年5月至2016年5月收治的根治性膀胱全切除原位乙状结肠代膀胱80例患者的资料,根据临床训练方法分成两组,将采取普通膀胱功能训练40例患者设为对照组,将采取系统性膀胱功能训练的40例患者设为观察组,比较两组的临床效果和尿流动力学特征.结果:观察组术后9个月残尿量、膀胱容量和最大尿流率等尿流动力学指标均优于对照组,且术后膀胱输尿管吻合口狭窄、夜间尿失禁、输尿管返流等总并发症发生率(2.50％)低于对照组(25.00％),差异均有统计学意义(P<0.05);观察组总体健康评分(83.40±14.30)高于对照组(65.33±13.10),差异有统计学意义(P<0.05).结论:对根治性的膀胱全切除原位乙状结肠代膀胱患者采取系统性膀胱功能训练能够改善尿流动力学指标,减少术后并发症且提高生活质量.     

腹腔镜下膀胱根治性切除联合原位U形与W形回肠新膀胱术治疗膀胱癌的临床疗效比较

目的 比较腹腔镜下膀胱根治性切除联合原位U形与W形回肠新膀胱术治疗膀胱癌的临床疗效。方法 回顾性分析行腹腔镜下膀胱根治性切除联合原位回肠新膀胱术的68例患者的临床资料,根据回肠新膀胱的构建方式将其分为2组,U组28例患者构建U形新膀胱,W组40例患者构建W形新膀胱。比较2组患者围术期相关指标、术后随访情况及术后并发症情况。结果 U组患者手术时间及术后排气时间短于W组(P 0. 05); 2组患者术中出血量及术后住院时间比较,差异无统计学意义(P 0. 05)。U组患者新膀胱容量小于W组(P 0. 05); 2组患者最大尿流率及残余尿量比较,差异无统计学意义(P 0. 05)。2组患者夜间尿控满意率均低于日间尿控满意率(P 0. 05)。2组患者术后并发症总发生率比较,差异无统计学意义(P 0. 05);U组患者术后尿失禁发生率高于W组(P 0. 05),其余术后并发症发生率2组比较差异无统计学意义(P 0. 05)。结论 与U形膀胱相比,W形膀胱具有更大的膀胱容量和更低的尿失禁发生率,但W形膀胱手术时间及术后排气时间较长,患者术后胃肠道功能恢复较慢。     

阑尾原位输出道的可控性回结肠膀胱术

目的　探讨阑尾原位输出道的可控性回结肠膀胱术的临床效果 .方法　回结肠袢 ,纵形剖开成肠片 ,拼缝成囊袋 .间断切断结肠带 .阑尾原位经右下腹引出造口 .共为 11例膀胱癌患者实施了膀胱全切、阑尾原位输出道的可控性回结肠膀胱术 .结果　储尿囊容量 40 0～ 6 0 0ml,内压平均为 2 7± 6 8cmH2 O ,无尿液溢漏 ,自我导尿方便 ,造口小无需覆盖 .随访 6个月至 4年 ,临床效果满意 .结论　该术式方法简便 ,控尿能力可靠 ,储尿囊容量大、压力低 ,节省肠袢 ,自我插管方便 ,并发症少 ,明显提高了患者生活质量     

针对性护理配合在膀胱全切原位回肠代膀胱术中的应用效果

目的 观察护理配合在经腹腔镜下膀胱全切原位回肠代膀胱术中的应用效果。方法 回顾性分析2018年3月~2019年3月在我院行膀胱全切除原位回肠代膀胱术实施针对性手术配合的48例膀胱癌患者。观察患者手术时间、术中出血量、肠功能恢复时间、新膀胱功能、并发症发生情况及护理满意度。结果 48例患者手术时间5~9 h,平均手术时间（5.98±0.45）h,术中出血量200~1000 ml,平均出血量（398.50±20.64）ml。术后2~3 d胃肠功能恢复,术后3周回肠代膀胱造影、静脉肾盂造影显示,双肾良好,无输尿管反流、梗阻,充盈良好。所有患者术后均未发生尿失禁、排尿困难等并发症。护理满意度调查,满意28例,一般18例,不满意2例,满意度为95.83%。结论 经腹腔镜下膀胱全切除原位代膀胱术患者采用针对性护理配合,可促进术后恢复,预防并发症发生,且术后膀胱功能良好,值得临床推广应用。     

原位尿流改道临床应用（附6例报告）

2006年5月以来,笔者对5例多发性膀胱癌和1例结核性挛缩膀胱患者,行膀胱全切除回肠代膀胱原位尿流改道,效果满意,现报告如下。1资料与方法1.1临床资料本组6例,年龄41~70岁,平均56岁。病程2~48个月,平均16个月,术前均行B超、KUB IVU,膀胱镜活检,未发现上尿路伴发肿瘤及尿道侵犯;T     

膀胱根治性全切Bricker膀胱术后近期并发症及其处理

目的探讨浸润性膀胱癌膀胱根治性全切回肠膀胱术(Bricker术)后近期并发症及其处理。方法2011年7月~2014年7月，本院完成膀胱根治性全切Bricker膀胱术43例，本组男性33例，女性10例；年龄45~74岁，平均年龄61岁。其中移行细胞癌35例、鳞状细胞癌2例、腺癌4例。本文手术近期并发症进行分析。结果术后近期并发症的出现主要为：尿漏2例(4.6%)，3例术后由于肠粘液堵塞输尿管吻合口及输出道引起腰背部胀痛及发热(6.9%)，手术后切口感染5例(11.6%),其中2例因回肠吻合口伤口瘘引起(4.6%)，不完全性肠梗阻2例(4.6%)，总的并发症发生率为27.9%。通过积极的临床处理，近期并发症完全治愈，无二次手术。结论回肠膀胱术(Bricker)手术操作相对简便、术后尿路通畅性可靠、并发症少，仍是膀胱癌根治术后尿流改道的主要方式。     

组织工程复合物进行兔尿流改道

背景：根治性膀胱切除是目前对于肌层浸润性膀胱癌最有效的治疗手段,膀胱切除后尿流改道需利用肠道,并发症较多。 目的：试用膀胱脱细胞基质和尿路上皮细胞构建组织工程化卷管进行尿流改道。 方法：制作兔脱细胞基质,体外培养扩增兔膀胱上皮细胞,将上皮细胞种植到兔脱细胞基质上,培养7 d后制作成4 cm长的卷管;新西兰兔28只,其中实验组24只,分6组每组4只,分别行保留膀胱三角区的膀胱大部分切除,再将膀胱三角区与组织工程化卷管吻合,网膜包裹卷管;对照组4只,利用未种植细胞的脱细胞基质制作成流出道并与膀胱三角区吻合。分别于手术后1,2,4,8周取标本做苏木精-伊红染色,8周后对复合物进行免疫组织化学检测。 结果与结论：实验组所有的动物均存活,苏木精-伊红染色显示流出道覆盖上皮,随着时间的推移,种植的上皮细胞与脱细胞基质逐渐融合,8周后免疫组织化学可见抗细胞角蛋白单克隆抗体 AE1/AE3阳性,抗ZO-1抗体阳性,证实流出道组织内有成熟上皮细胞覆盖,尿路上皮细胞之间有连接功能;对照组4只兔术后2周内均死亡,尸体解剖见流出道瘢痕形成,闭锁,双肾重度积水。结果表明,利用种植有尿路上皮细胞的脱细胞基质制作成组织工程化卷管在动物体内进行尿流改道是可行的,流出道内腔有成熟上皮覆盖,具有防止尿外渗的功能。     

Orthotopic ileal neobladder versus sigmoidal neobladder: a "quality of life" (QOL) survey

To compare the quality of life (QOL) in patients with ileal neobladder and sigmoidal neobladder, a retrospective survey was conducted using a formulated questionnaire. Between January and March 1999, a QOL survey was conducted using self-administered questionnaires (EORTC QLQ-C30, IPSS, supplemented with detailed questionnaires about continence, sexual function, and patient's satisfaction with the selected urinary diversion method) for 78 patients with orthotopic urinary reservoir (OUR) who were followed-up for more than 3 months after cystectomy. Among 78 patients, 63 had OUR using an ileal segment (male/female=59/4, median age: 70.8 years old, median follow-up: 1.7 years). Fifteen patients had OUR using a sigmoidal segment (male/female=13/2, median age: 71.9, median follow-up: 3.9). The QLQ-C30 functional evaluation and the items in relation to sexual function showed no differences between the 2 groups. Concerning the voiding condition, bladder emptying, frequency, and urgency, scores in the sigmoidal OUR group were significantly higher. The QOL score concerning voiding conditions, daytime, and nighttime continence and quantity of pad showed a better score in the ileal OUR group. Concerning the satisfaction with methods of urinary diversion, patients in the sigmoidal OUR group expressed less satisfaction than their preoperative expectations. Considering several postoperative voiding conditions, ileal OUR seems superior to sigmoidal OUR.     

Health-related quality of life after radical cystectomy for bladder cancer in elderly patients with an ileal conduit, ureterocutaneostomy, or orthotopic urinary reservoir: a comparative questionnaire survey

To compare the health-related quality of life of elderly patients after radical cystectomy for bladder cancer in urinary diversion groups: ileal conduit, ureterocutaneostomy, or orthotopic urinary reservoir. The 109 participating elderly patients aged 75 or older completed self-reporting questionnaires: the QLQ-C30, and on satisfaction with urinary diversion methods. Fifty-six patients had undergone constructions for ileal conduit diversion, 31 for ureterocutaneostomy, and 22 for orthotopic urinary reservoir (OUR). The median follow-up period for each group was 4.0 years (range 0.3-11.2), 4.5 years (range 0.3-18.0), and 3.3 years (range 0.3-6.7), respectively. Regardless of the type of urinary diversion, the majority of patients reported having good overall quality of life, although with some problem of pain. No significant differences among urinary diversion subgroups were found in any quality of life area in the QLQ-C30 questionnaire. More patients in the OUR sub-group felt disappointment than those in the ileal conduit or cutaneostomy sub-groups. However, a questionnaire which asked which diversion method would be preferable showed a trend that more patients in the OUR subgroup would have chosen the same one. Health-related quality of life appeared relatively good in these 3 groups. Patient demands and expectations may be so different from the results that the details of each urinary diversion method should be explained thoroughly. OUR construction could be a candidate even for elderly patients.     

Urothelial carcinoma involving vaginal specimens from patients with neobladder: a potential pitfall in diagnostic cytopathology

Most vaginal neoplasms represent metastasis from the cervix, endometrium, colon and ovary and distinction from a primary lesion does not pose a diagnostic problem. Recently, it has been recognized that women with urothelial carcinoma (UC) who have undergone radical cystectomy with orthotopic neobladder reconstruction are at risk for recurrence in the lower gynecologic tract. Our objective is to describe the cytologic features of cases with confirmed UC in the vagina in this clinical setting. Four vaginal specimens from patients with prior radical cystectomy and orthotopic neobladder reconstruction with histologically confirmed UC were evaluated. The vaginal specimens consisted of Thinprep® and Papanicolaou‐stained slides. Cytomorphologic parameters including cellular arrangement, cell size and shape, cytoplasm, and nuclear features were evaluated and compared with a corresponding surgical biopsy. All four cases were highly cellular with abundant neoplastic cells arranged singly and in loose three‐dimensional clusters with overlapping nuclei. The neoplastic cells were large and polygonal with well‐defined cell borders, high nuclear to cytoplasmic ratio, and granular basophilic cytoplasm. The chromatin was coarse with small nucleoli. Scattered keratinized single cells with atypical hyperchromatic nuclei were observed in each case. In summary, UC involving the vagina can share many morphologic features with primary squamous cell carcinomas at this site, including focal keratinization. Abundant three dimensional clusters of neoplastic cells and a previous history of orthotopic neobladder reconstruction are helpful cytomorphologic and clinical features supporting a diagnosis of UC involving the vagina and may prevent unnecessary work‐up for a new primary lesion. Diagn. Cytopathol. 2011. © 2010 Wiley Periodicals, Inc.     

解剖性保留控尿肌群技术在腹腔镜根治性前列腺切除术中的临床应用价值

目的 探讨腹腔镜前列腺癌根治术（LRP）中解剖性保留控尿肌群技术对术后早期控尿功能恢复的影响,及其肿瘤学安全性。方法 回顾性队列研究。纳入2016年1月—2020年6月浙江大学医学院附属金华医院泌尿外科采用LRP治疗的前列腺癌患者共292例,将其中采用解剖性保留控尿肌群技术的83例纳入观察组;对另外209例接受经典前列腺癌根治术的患者与观察组患者进行1∶1倾向性评分匹配,选择其中83例纳入对照组。全组共166例,年龄45~75（64.0±7.3）岁,BMI 21~31（24.4±2.4）kg/m²。对比分析2组患者手术时间、术中出血量、术后病理TNM分期、Gleason评分、术后留置导尿时间、手术并发症和手术切缘阳性（PSM）率;采用Kaplan-Meier法评估患者3年、5年无生化复发（BCR）累积生存率;根据术后每天使用的尿垫数量进行控尿功能分级评估,分别于拔除导尿管后的当天（第1个24 h）、1周及1、3、6、12个月时,观察并对比2组患者控尿功能恢复情况。结果 2组患者年龄、临床分期、危险分级、膀胱颈和神经保留与否等临床基线特征比较,差异均无统计学意义（P值均>0.05）。全组166例均在腹腔镜下完成手术,术后恢复良好,无围手术期死亡病例。2组患者手术时间、术中出血量、术后病理TNM分期、术后Gleason评分、术后留置导尿时间和手术并发症比较,差异均无统计学意义（P值均>0.05）。观察组PSM率为10.84％（9/83）,低于对照组的13.25%（11/83）,但差异无统计学意义（χ²=0.23, P=0.633）。2组患者术后随访12~71个月,平均33.73个月。随访期间无死亡病例。观察组3年、5年无BCR累积生存率分别为90.2％和73.2%,对照组分别为91.4%和77.8%,2组差异无统计学意义（χ²=0.38, P=0.535）。在拔除导尿管后当天、1周及1、3、6个月,观察组完全控尿率分别为39.76%（33/83）、53.01%（44/83）、66.27%（55/83）、90.36%（75/83）和97.95%（81/83）,对照组为16.87%（14/83）、21.96%（18/83）、38.55%（32/83）、53.01%（44/83）和68.67%（57/83）;观察组控尿功能分级均优于对照组,差异均有统计学意义（Z=-4.24、-4.09、-3.78、-5.61、-4.99,P值均<0.001）;拔管后12个月,2组完全控尿率分别为98.80%（82/83）和93.98%（78/83）,控尿功能分级比较差异无统计学意义（Z=-1.67,P=0.094）。术后3个月,观察组控尿（完全+社交）率达100％（83/83）,高于对照组的73.49%（61/83）,差异有统计学意义（χ²=25.36, P<0.001）。结论 LRP中解剖性保留控尿肌群技术的应用有助于患者术后早期恢复控尿功能,且不影响手术的肿瘤学安全性。     

Prolift网片与聚丙烯网片在全盆底重建治疗中的对比

BACKGROUND: A large number of studies focused on mesh application in the whole pelvic floor reconstructive surgery, but the comparative research on the Prolift mesh and polypropylene mesh (Gynemesh) in the whole pelvic floor reconstruction is rarely reported. OBJECTIVE: To compare the Prolift mesh with Gynemesh in the whole pelvic floor reconstructive surgery. METHODS: Totally 90 female patients with pelvic organ prolapse were enrolled, aged 40 to 80 years old, and were randomly divided into Prolift group and Gynemesh group, who were subjected to full pelvic floor reconstruction with Prolift mesh or Gynemesh, respectively. Afterwards, operation time, intraoperative blood loss, postoperative vaginal bleeding, hematoma, local paresthesia, urinary retention, overactive bladder, residual urine, postoperative incision infection, mesh exposure and postoperative quality of life were compared in two groups. RESULTS AND CONCLUSION: No hematoma, local paresthesia, urinary retention and rejection reactions appeared in both two groups. The operation time, intraoperative blood residual urine, length of stay, catheter retention time had no significant differences between two groups. In the Prolift group, one case had a small amount of vaginal bleeding, one case had overactive bladder, five cases had mesh exposure at the anterior wall of vaginal, and two cases had light stress urinary incontinence; in the Gynemesh group, no vaginal bleeding, overactive bladder and stress urinary incontinence occurred, but four cases had mesh exposure at the anterior wall of vaginal. Additionally, the scores on the quality of life in the two groups at the last follow-up were significantly lower than those before surgery (P < 0.05), but there was no significant difference between the two groups (P > 0.05). These results demonstrate that both Prolift system and Gynemesh are safe and effective for the whole pelvic floor reconstruction, resulting in few postoperative complications. Patients can quickly recover, and obtain satisfactory outcomes.     

Adenocarcinoma and dysplasia in an ileal neobladder after ileocystoplasty for interstitial cystitis

We report a 54-year-old woman with an adenocarcinoma of an ileal neobladder arising upon a background of ileal mucosal dysplasia. We believe that no case study or report has previously documented neobladder ileal mucosal dysplasia adjacent to an ileal neobladder adenocarcinoma. This observation supports the current hypothesis that ileal neobladders are dynamic environments for potential malignancy, and moreover, suggests a sequence of morphologic and molecular derangements similar to that seen in colorectal carcinoma. Those patients status post ileal neobladder are at risk for glandular dysplasia and malignancy and should be followed closely.     

新辅助化疗治疗宫颈癌43例临床分析

目的探讨新辅助化疗在Ib～1Ib期宫颈癌辅助治疗中的临床效果。方法43例宫颈癌患者术前采用2个疗程的静脉化疗,化疗结束后2-3周全部行宫颈癌根治术。通过观察患者的化疗毒副反应、术中情况、术后病理反应及术中术后并发症,评价新辅助化疗在宫颈癌治疗中的作用。结果43例术后病理阴道切缘及宫旁切缘均无癌残留。术前化疗组与直接手术组比较,术前化疗组较直接手术组的病理情况（淋巴结阳性,宫旁累及阴道切缘阳性）差异有统计学意义（P〈0．05）,术前化疗组较直接手术组的术中出血量、术中血管、膀胱、输尿管损伤及术后下肢水肿差异有统计学意义（P〈0．05）,而术前化疗组与直接手术组手术时间、术中术后并发症（尿潴留、淋巴囊肿、便秘以及膀胱麻痹）方面的差异均无统计学意义。结论宫颈癌术前新辅助化疗并不增加手术时间、术中出血量及术后并发症,是比较安全有效的治疗方法,应用于临床对病灶缩小、术中减少出血、提高手术切净率效果显著。