女性膀胱癌患者原位回肠和乙状结肠尿流改道效果的比较

背景：原位尿流改道在膀胱癌根治术后具有良好的控尿能力,但针对女性膀胱癌患者行原位回肠重建新膀胱和原位乙状结肠重建新膀胱后疗效及随访方面的研究很少。目的：比较女性膀胱癌患者原位回肠和乙状结肠尿流改道的临床疗效。方法：回顾性分析 1996 至 2008 年行膀胱癌术后原位回肠尿流改道（回肠组,n=29）和乙状结肠尿流改道（乙状结肠组,n=23）的女性膀胱癌患者的临床资料。比较分析两组患者修复中及修复后的一般情况、尿动力学结果、控尿能力和修复后储尿囊相关并发症等。结果与结论：平均随访时间回肠组 57 个月,乙状结肠组 55 个月。两种修复方式术中失血量、术后控尿效果接近,但两组在手术时间、治疗后下床时间、新膀胱容量等方面差异有显著性意义（P 〈 0.05）。回肠组治疗后早期及晚期储尿囊相关并发症发生率均高于乙状结肠组。回肠组治疗后储尿囊再发肿瘤 2 例,乙状结肠组未见发生,说明两种重建方式应用于女性膀胱癌患者疗效均良好。     

膀胱癌永久性回肠代膀胱手术患者伤残接受度及创伤后成长调查

目的 调查膀胱癌永久性回肠代膀胱手术患者伤残接受度及创伤后成长水平现状。方法 应用便利抽样法,选取2018年1月-2019年5月在我院泌尿外科住院的122例行膀胱全切加回肠代膀胱术后的膀胱癌患者。采用残疾接受度量表及创伤后成长量表对其进行横断面调查。结果 患者残疾接受度平均分为(78.18±15.81)分,为中度接受水平,创伤后成长平均分为(66.45±15.87)分,处于较高水平。结论 护理人员应关注膀胱癌永久性回肠代膀胱手术患者伤残接受度以及创伤后成长水平,制定个性化心理干预方案,以增强患者术后回归正常生活的信心,从而加快康复训练的进程,最终提升其生活质量和希望水平。     

腹腔镜下全膀胱切除原位回肠新膀胱术（附16例报告）

目的探讨在基层医院采用腹腔镜下全膀胱切除原位回肠新膀胱术的临床应用。方法对15例浸润性膀胱尿路上皮细胞癌Ⅱ～Ⅲ级、1例鳞状细胞癌患者行腹腔镜下全膀胱切除加原位回肠代膀胱术,观察手术时间、术中出血量、术后肠道功能恢复情况及术后并发症等手术效果。结果 16例患者膀胱根治均切除成功,手术时间240～320min。腹腔镜下失血量为100～500ml,平均为230ml。2例输浓缩红细胞2个单位。术后3d恢复肠蠕动并拔除耻骨后引流管,4d后开始进食。2周后拔除输尿管支架管。随访4～26个月,1例有排尿困难,5例术后早期出现轻微尿失禁,所有病例术后3个月均可完全控制排尿,5例男性患者有勃起功能障碍。16例均无复发。结论该术式具有微创、出血少、恢复快等特点,将成为治疗浸润性膀胱癌的安全、有效的方法之一,有可能在具有一定腹腔镜手术操作基础的基层医院逐步开展。     

改良膀胱全切原位新膀胱术21例

目的 观察采用膀胱全切改良肠道原位新膀胱术治疗浸润性膀胱癌的效果.方法 对21例男性浸润性膀胱癌患者采用改良法全膀胱切除,其中17例用改良回肠原位新膀胱,4例用乙状结肠原位新膀胱.术后随访1～4年,对这些患者术后新膀胱功能、控尿和排尿功能、上尿路形态和功能、血电解质和生活质量进行评价.结果 本组21例手术顺利,手术时间3.5～6.5 h,平均4.5h.输血4例,无围手术期死亡病例.病理报告均为移行上皮细胞癌.白天控制排尿良好15例,夜间控制排尿良好6例,多在术后3～6个月时完全控制排尿.5例术后不同程度肾积水,6～8个月恢复正常.无膀胱输尿管返流.1例残余尿量30 ml,1例残余尿量40ml,出现肠梗阻、代谢性酸中毒各1例.随访1～4年,1例25个月时因车祸死亡,1例肿瘤浸润膀胱壁者,淋巴结阳性,术后拒绝化疗,14个月后远处转移死亡,余19例生存良好.结论 改良全膀胱切除原位新膀胱术后肿瘤控制满意,严重并发症少,新膀胱控制排尿良好,患者生活质量高,是目前治疗浸润性膀胱癌的理想方法之一.     

膀胱癌全切回肠代膀胱腹壁造口病人术后真实体验的质性研究

[目的]了解膀胱癌全切回肠代膀胱腹壁造口病人术后真实体验.[方法]采用目的抽样法,选择15例膀胱癌术后腹壁造口病人,进行开放式半结构式深度访谈,对结果进行录音和笔录,运用Nancy现象学7步分析法进行资料分析.[结果]得到5个主题,即手术后病人的情感反应,造口对生活的改变,来自疾病本身的压力,对医疗护理方面的需求,来自经济的压力.[结论]膀胱癌腹壁造口病人术后经历了艰难的心理体验;住院期间尚未适应造口,造口护理知识缺乏.护理人员应重视病人术后初期的社会心理变化,积极采取有效方式帮助病人尽早适应造口,回归社会.     

51例行膀胱全切原位回肠代膀胱术老年患者的围手术期护理

总结了51例行膀胱全切原位回肠代膀胱术治疗膀胱癌老年患者的围手术期护理。术前做好心理、肠道护理及全身准备,术后加强引流管护理、新膀胱冲洗护理及新膀胱功能的训练及基础护理。51例患者术后未发生感染、尿瘘、吻合口痿等并发症,随访3-18个月,所有患者均能自主控尿。     

腹腔镜下膀胱切除-乙状结肠代膀胱术的护理

目的:探讨腹腔镜根治性膀胱切除-乙状结肠原位新膀胱术治疗浸润性膀胱癌的护理方法。方法:对18例浸润性膀胱癌患者在术前做好心理护理、术前宣教和肠道准备,术后严密观察病情、做好各引流管的护理和并发症的观察与处理,以及指导患者定时排尿和进行盆底肌的训练。结果:18例患者手术成功,患者恢复良好,术后5~7 d恢复饮食,2周后拔除盆腔引流管,3~4周拔除膀胱造瘘管,5~6周拔除导尿管及双侧输尿管支架管。患者拔除尿管后,经过对新建膀胱进行排尿功能训练,2周后可自控排尿,仅1例患者夜间偶有尿失禁。结论:腹腔镜根治性膀胱切除-乙状结肠原位新膀胱术治疗浸润性膀胱癌,配合围术期精心护理,可提高手术成功率,减少术后并发症,减轻患者痛苦,促进患者康复。     

腹腔镜根治性膀胱全切+原位回肠新膀胱术治疗浸润性膀胱癌

目的探讨腹腔镜根治性膀胱全切+原位回肠新膀胱术的手术方法和经验。方法回顾分析2011年3月-2014年10月该院14例浸润性膀胱癌患者的临床资料。结果 13例成功施行了腹腔镜根治性膀胱全切+原位回肠新膀胱术,1例因术中膀胱内肿瘤出血增加术野无法显露而中转开放手术。12例在直视下行新膀胱尿道间断吻合,2例在腹腔镜下采用单针连续缝合法行新膀胱尿道吻合。手术平均时间444 min,术中平均出血量490 ml。术后病理提示12例为膀胱尿路上皮癌,其中1例伴部分鳞状细胞癌,2例为膀胱腺癌。2例患者术后出现尿漏,经保守治疗后治愈,1例术后出现尿失禁。术后随访6~56个月,3例死于肿瘤远处转移,1例目前发生肿瘤颅内转移。其余10例目前仍无瘤生存,其中1例术后1年出现尿道内口狭窄,经行尿道狭窄内切开术后治愈。10例患者目前控尿功能恢复良好,新膀胱容量约300 ml。结论腹腔镜根治性膀胱全切+原位回肠新膀胱术治疗膀胱癌疗效确切、安全、创伤小及术后恢复快,可作为临床浸润性膀胱癌的首选治疗方法。     

膀胱癌膀胱全切原位回肠新膀胱术患者自护能力与社会支持相关性分析

目的 探讨膀胱癌膀胱全切原位回肠新膀胱术患者自我护理能力与社会支持状况的相关性.方法 将99例行膀胱全切原位回肠新膀胱术的膀胱癌患者按照自我护理能力量表评分分为自护能力低下组与自护能力良好组,比较两组一般资料及社会支持量表评分,分析患者自护能力及社会支持状况的相关性.结果 入组患者自护能力低下48例,自护能力良好51例...     

原位回肠与乙状结肠尿流改道再造膀胱:10年资料回顾

背景:长期随访结果发现,原位回肠尿流改道再造膀胱方法可致酸碱平衡及营养代谢障碍,另外回肠位置较高,必须有较长的系膜方可使膀胱位于盆腔且与尿道吻合处的张力不致过高.而乙状结肠位置靠近尿道,且原位乙状结肠尿流改道再造膀胱具有对电解质酸碱平衡及营养代谢影响较小,分泌黏液较少等特点.目的:采用长期随访形式比较膀胱癌患者采用回肠和乙状结肠再造膀胱的优劣.设计:回顾性分析.单位:昆明医学院第二附属医院泌尿外科.对象:选择1995-01/2005-03昆明医学院第二附属医院泌尿外科住院的膀胱癌患者164例.行原位回肠尿流改道再造膀胱96例(回肠组),男74例,女22例,年龄43～74岁;行原位乙状结肠尿流改道再造膀胱68例(乙状结肠组),男64例,女4例,年龄51～72岁.所有患者均经病理检查确诊;患者及家属均对治疗方案知情同意.治疗方案经医院伦理委员会批准.方法:①原位回肠尿流改道再造膀胱:膀胱全切后,距回盲瓣15～20 cm处截取40～60 cm长带蒂回肠袢制作储尿囊,双侧输尿管吻合于两端预留肠管,储尿囊最低部与尿道残端吻合.②原位乙状结肠尿流改道再造膀胱:膀胱全切后,截取30～40 cm长带蒂乙状结肠制作储尿囊.双侧输尿管同上法吻合于近端预留肠管.主要观察指标:观察手术时间、术中失血量、下床活动时间、术后留置单J管及尿管时间.以定期复诊的方式进行随访,观察患者控尿排尿能力、尿动力学分析结果以及术后早期与晚期膀胱相关并发症.结果:164例患者失访12例(7.3%).回肠组平均随访46个月,乙状结肠组为42个月.两组术中失血量、术后控尿效果相近(P >0.05),原位回肠尿流改道组手术耗时较长,术后恢复较慢,新膀胱容量较大(t =2.56～3.08,P < 0.05～0.01).原位回肠尿流改道组术后早期及晚期膀胱相关并发症发生率分别为16.7%,29.2%,均高于乙状结肠组(9%,16%),其中晚期并发症发生率比较,差异有显著性意义(χ2 = 5.426,P < 0.05).结论:原位乙状结肠尿流改道再造膀胱耗时短、恢复快、术后并发症发生率低.     

Surveillance of patients with bladder cancer following cystectomy: yield of CT urography

Purpose

To determine the yield of CT urography (CTU) in the surveillance of patients with bladder cancer following cystectomy.

Materials and methods

In this IRB-approved, HIPAA-compliant, retrospective study of 5,404 CT urograms performed at our institution between March 2000 and February 2011, 225 CT urograms were performed in 105 patients [79 men, 26 women; mean age 65 years (43–85)] following cystectomy for bladder cancer. Median follow-up after cystectomy was 63 months (range 1–234), median time between cystectomy and CTU was 39 months (range 0–229), median follow-up after CTU was 34 months (range 1–111). CTU examinations were reviewed by two radiologists in consensus and findings were categorized into those related to surgery, locoregional recurrence, metastases, or metachronous upper tract urothelial tumor (UTT).

Findings

Findings were present in 69 (65.7 %) of 105 patients, including findings related to surgery in 60 (57.1 %) patients, locoregional recurrence or metastatic disease in 21 (20 %) patients, and UTT in 3 (2.9 %) patients. Of surgery-related findings, hydronephrosis (23/105, 21.9 %) and parastomal hernia (17/105, 16.2 %) were the most common findings. Visceral metastases (16/105, 15.2 %) and lymph node metastases (13/105, 12.4 %) were the most common manifestations of recurrent disease.

Conclusion

CTU findings in the surveillance of patients with bladder cancer after cystectomy are common and include those related to surgery, spread of the disease, and metachronous tumors. Our study supports current published guidelines on the use of CTU in these patients.     

Detection of bladder cancer recurrence with real-time three-dimensional ultrasonography-based virtual cystoscopy

This prospective study evaluated the accuracy of grey-scale two-dimensional (2D) ultrasonography and real-time threedimensional (3D) ultrasonography-based virtual cystoscopy for detecting early recurrence of bladder cancer in previously treated patients (n = 40). Real-time 3D ultrasonography-based virtual cystoscopy images were compared with both 2D ultrasonography and interval conventional cystoscopy pathology results. Ultrasound examinations were performed before routine follow-up with conventional cystoscopy. Overall sensitivity for real-time 3D ultrasonography-based virtual cystoscopy was lower than for 2D ultrasonography, indicating it did not provide additional information. The results of combined (2D and 3D) ultrasonography and conventional cystoscopy differed significantly. Where lesions were detected with combined ultrasonography, the number of previous cystoscopies was lower and the tumour stage was significantly higher at initial diagnosis, compared with cases where no lesions were detected. The results suggest that ultrasonography before cystoscopy can be performed more frequently - or, if no lesions are detected by ultrasonography, the interval between cystoscopies can be prolonged - in patients at high risk of bladder cancer recurrence.     

Hepatic acetylator phenotype in bladder cancer patients

We determined the hepatic acetylator phenotype in 130 patients with transitional-cell carcinoma (urothelioma) of the bladder and, previously in 157 normal control subjects. Eighty-three patients (63.8%) and 90 control subjects (57.4%) were slow acetylators (p greater than 0.05). Patients of both phenotypes did not differ in the consumption of tobacco and coffee. Seventy-five patients were not exposed to occupational risk for bladder cancer and the distribution of acetylator phenotype in them was similar to that of the control group. The other 55 patients had been employed in jobs with an elevated risk for urotheliomas; 41 (74.5%) were slow acetylators, which represented a significant excess over the incidence of slow acetylators in the control group (57.4%) (p less than 0.05); 15 of these patients had worked in jobs with carcinogenic arylamines proven in the workplace environment (11 were slow acetylators). Our results suggest that the slow acetylator phenotype can facilitate the development of urothelioma in individuals with occupational risk.     

丝裂霉素与吡柔比星膀胱热灌注预防浅表性膀胱癌术后复发的疗效对比观察

目的观察浅表性膀胱癌患者行经尿道膀胱肿瘤电切术（TUR-Bt）后分别采用丝裂霉素（MMC）和吡柔比星（THP）进行膀胱热灌注预防肿瘤复发的不同疗效。方法将56例浅表性膀胱癌术后患者随机分为两组,分别用MMC、THP做为膀胱灌注治疗药物,利用体腔热灌注治疗机循环模式进行膀胱灌注,观察其不同疗效。结果所有患者随访12～24个月,平均16个月。MMC组复发5例,THP组复发1例,THP组复发率低于MMC组（P〈0.05）,且不良反应小。结论 THP热灌注疗效优于MMC,不良反应小,耐受性好,可以作为一种新疗法,值得推广。     

全膀胱尿道切除回肠膀胱术治疗膀胱癌26例疗效探讨

目的探讨膀胱癌行全膀胱及尿道切除回肠膀胱术（Bricker术）的临床治疗效果。方法回顾性分析26例膀胱癌患者,一期施行膀胱及尿道全切回肠代膀胱尿流改道术的临床资料。结果所有病例术后均恢复良好,出现近期并发症5例,无远期并发症。26例均获随访1～10年,平均6.2年,5年生存率67.5%。结论对于膀胱癌侵犯尿道及前列腺无法保留尿道的患者,采取一期切除膀胱及全尿道回肠膀胱尿流改道术,操作简单易行,术后恢复快、并发症少、疗效确切,推荐为此类患者的优先选择。     

血清趋化因子配体5预测膀胱癌外科治疗后复发的价值

目的探讨血清趋化因子配体5(CXCL5)对膀胱癌外科治疗后复发的预测价值。方法选取行膀胱癌根治术的98例患者,根据病理分期分为肌层浸润性膀胱癌(MIBC)组和非肌层浸润性膀胱癌(NMIBC)组,比较2组的血清CXCL5水平和复发率,并分析所有患者术前血清CXCL5水平与其临床病理特征的关系。采用受试者工作曲线下面积(AUC)来评价其对膀胱癌复发的预测价值。结果 MIBC组的术前血清CXCL5水平均显著高于NMIBC组(P0.05)。年龄60岁、肿瘤位于膀胱底或膀胱体、M_1期、G_2~G_3级者的术前血清CXCL5水平显著升高(P0.05)。所有患者共随访6~36个月,复发36例(36.7%),MIBC组的复发率显著高于NMIBC组,复发者术前血清CXCL5水平显著高于无复发者(P0.05)。ROC曲线分析结果表明,术前血清CXCL5水平对MIBC、NMIBC的AUC为0.861(0.669~0.960,P0.05)、0.819(0.630~0.933,P0.05),其最佳临界值分别为828.9、589.3 pg/m L。结论术前血清CXCL5水平对膀胱癌患者术后复发有较好的预测价值。     

非肌层浸润性膀胱癌的复发及进展风险因素回顾分析

目的探讨分析影响非肌层浸润性膀胱癌复发、进展的风险因素及其临床意义。方法回顾分析北京大学首钢医院2007年1月至2013年12月收治的非肌层浸润性膀胱癌患者的全部病例资料,对性别、年龄、肿瘤大小、肿瘤数目、肿瘤分级、肿瘤分期、既往复发频率、是否合并原位癌及术后膀胱灌注等因素进行生存分析,定义复发或进展为终点事件,运用Log-Rank检验,Kaplan-Meier法单因素分析比较各因素无病生存率差异,Cox比例风险回归模型多因素分析复发、进展的独立风险因素。结果共有188例非肌层浸润性膀胱癌患者纳入研究,就诊时平均年龄67.3岁,男∶女=5.9∶1,随访时间8~134个月,复发98例(总复发率52.1%),进展27例(总进展率14.4%)。单因素分析发现,肿瘤大小、数目、分级、分期及既往复发次数与复发相关有统计学意义(均P<0.05),原位癌、肿瘤大小、分级、分期及既往复发次数与进展相关,有统计学意义(均P<0.05)。Cox回归模型多因素分析发现,肿瘤数目为复发的独立风险因素(风险比HR=1.81);原位癌、肿瘤大小、肿瘤分级及既往1年复发次数为疾病进展的独立风险因素(均P<0.05),分别HR=3.54、HR=3.22、HR=3.42、HR=2.73。结论肿瘤数目是非肌层浸润性膀胱癌复发的独立风险因素,肿瘤大小、分级及既往复发频率则显著影响着非肌层浸润性膀胱癌的进展。     

吡柔比星灌注预防膀胱癌术后复发的观察及护理

目的：探讨膀胱灌注吡柔比星预防浅表性膀胱癌术后复发的疗效及安全性。方法：对116例浅表性膀胱癌患者行经尿道膀胱肿瘤电切术或膀胱部分切除术,术后1周开始用吡柔比星进行膀胱内定期灌注,每次药物在膀胱内保留30～60 min,每周1次,连续8次。以后每月1次,连续10次。并随访5～72月。结果：患者均未见全身性药物不良反应,出现尿道烧灼感5例,轻微膀胱刺激症状7例;复发19例。结论：膀胱内吡柔比星灌注预防膀胱癌术后复发的疗效确切,不良反应小,安全性好,在灌药时加强对患者灌注前、灌注中及灌注后护理,可减轻患者不适感,提高患者灌药的依从性。     

Gelatinase isoforms in urine from bladder cancer patients

Matrix metalloproteinases are involved in tumor invasion and metastasis in many types of human carcinomas, in leukocyte infiltration and inflammatory reactions. Three metalloproteinases with gelatinolytic activity were isolated from the urine of patients with untreated high grade bladder cancer or with functioning renal grafts (control). Urinary proteins were fractionated after concentration by continuous-elution SDS-polyacrylamide gel electrophoresis. Collected fractions were analyzed by gelatin zymography and Western blotting. The one-step purification process isolated the gelatinase species from crude urine samples: (1) a 72 kDa progelatinase A (MMP-2) and its actived 68 kDa form; (2) a 92 kDa progelatinase B (MMP-9); (3) a higher molecular weight (HMW) complex (115 kDa) which was identified as progelatinase B associated with lipocalin, NGAL. A similar marker profile was observed in bladder cancer tissues. The current study demonstrated the efficiency of continuous elution electrophoresis. It offered two main advantages: (1) the separation of latent from active gelatinase isoforms with no interference from the TIMPs and (2) the identification and isolation in a single step of large amounts of urine gelatinase species with both high recovery and significant specific activities. Continuous-elution electrophoresis can be used for correlation with clinical events of bladder cancer diagnosis and prognosis.