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。     

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。     

膀胱低频电刺激训练对宫颈癌术后患者膀胱功能、尿动力参数及盆底肌力的影响效果探究

目的:探讨膀胱低频电刺激训练对宫颈癌术后患者膀胱功能、尿动力参数及盆底肌力的影响效果.方法:选取2020年4月至2022年6月我院收治的105例宫颈癌术后患者作为研究对象,以计算机分组法分为对照组(n=52)和观察组(n=53).对照组采取盆底肌肉训练,观察组在对照组基础上增加膀胱低频电刺激训练.观察两组膀胱功能、尿动力参数、盆底肌力以及尿潴留情况.结果:观察组尿管留置时间短于对照组,残余尿量(Post Void Residual,PVR)和膀胱功能等级明显低于对照组(P<0.05);观察组膀胱顺应性、膀胱逼尿肌收缩力、最大尿流率、盆底肌力均较对照组高(P<0.05);观察组尿潴留发生率较对照组低(P<0.05).结论:低频膀胱电刺激训练可以增强盆底肌肉力量,调节尿动力学参数,促进膀胱功能恢复,并有助于预防宫颈癌患者术后尿潴留.     

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。     

膀胱全切回肠代膀胱术患者的围术期护理

目的 总结膀胱全切除回肠代膀胱术病人的围术期护理.方法 对12例膀胱肿瘤的患者行膀胱全切回肠代膀胱术,术前做好心理护理、术前准备;术后密切观察病情及生命体征变化,予以对症护理及出院指导.结果 12例膀胱全切回肠代膀胱术无1例并发症发生,患者病情稳定,均取得满意的治疗效果.结论 加强膀胱全切除回肠代膀胱术病人的围术期护理是手术成功的保证.     

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。     

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。     

全膀胱切除胃代膀胱手术的护理配合

目的 总结全膀胱切除胃代膀胱术治疗膀胱癌患者的手术配合与护理经验。方法 通过术前访视和宣教，熟悉手术步骤，制定周密的手术护理计划，术中强调无菌技术及主动配合，对27例多发和复发性膀胱癌患者施行全膀胱切除、原位楔形胃代膀胱术。结果 所有患者手术经过顺利，术中病情平稳，术后恢复良好。结论 高质量的手术配合是顺利完成这一新的大型复杂手术的一个重要保证，不仅可以缩短手术时间，同时能减少术中、术后并发症。     

盆底肌肉训练联合神经肌肉刺激在改善高龄初产妇产后尿潴留患者膀胱功能中的作用机制分析

目的:研究神经肌肉刺激联合盆底肌肉训练对高龄初产妇产后尿潴留患者膀胱功能的影响.方法:选取本院我科于2019年9月至2020年12月期间收治的97例高龄初产妇产后尿潴留患者作为研究对象,采用随机数字表法分为对照组(n=48)和观察组(n=49).对照组患者采取神经肌肉刺激治疗,观察组在对照组的基础上增加盆底肌肉训练.对比两组患者治疗1 m后的自主排尿效果、干预前1 d和干预1 m后的膀胱容积、尿流情况,以及干预后3 m内尿潴留复发率.结果:干预后,观察组自主排尿总有效率、膀胱初感容积、最大膀胱容积、最大尿流率、最大尿流率时逼尿肌压力均明显高于对照组(P<0.05),观察组患者尿潴留复发率明显低于对照组(P<0.05).结论:神经肌肉刺激联合盆底肌肉训练对高龄初产妇产后尿潴留患者效果显著,能够有效促进患者自主排尿,加速膀胱功能恢复,降低尿潴留复发率,值得临床推广应用     

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.     

Febrile Urinary Tract Infection after Radical Cystectomy and Ileal Neobladder in Patients with Bladder Cancer

Urinary tract infection (UTI) is one of the most common complications after radical cystectomy and orthotopic neobladder reconstruction. This study investigated the incidence and implicated pathogen of febrile UTI after ileal neobladder reconstruction and identify clinical and urodynamic parameters associated with febrile UTI. From January 2001 to May 2015, 236 patients who underwent radical cystectomy and ileal neobladder were included in this study. Fifty-five episodes of febrile UTI were identified in 46 patients (19.4%). The probability of febrile UTI was 17.6% and 19.8% at 6 months and 24 months after surgery, respectively. While, Escherichia coli was the most common implicated pathogen (22/55, 40.0%), Enterococcus spp. were the most common pathogen during the first month after surgery (18/33, 54.5%). In multivariate logistic regression analysis, ureteral stricture was an independent risk factor associated with febrile UTI (OR 5.93, P = 0.023). However, ureteral stricture accounted for only 6 episodes (10.9%, 6/55) of febrile UTI. Most episodes of febrile UTI occurred within 6 months after surgery. Thus, to identify risk factors associated with febrile UTI in the initial postoperative period, we assessed videourodynamics within 6 months after surgery in 38 patients. On videourodyamic examination, vesicoureteral reflux (VUR) was identified in 16 patients (42.1%). The rate of VUR presence in patients who had febrile UTI was not significantly different from those in patients without febrile UTI (50% vs. 39.3%, P = 0.556). Patients with febrile UTI had significantly larger residual urine volume (212.0 ± 193.7 vs. 90.5 ± 148.2, P = 0.048) than those without. E. coli and Enterococcus spp. are common pathogens and ureteral stricture and residual urine are risk factors for UTI after ileal neobladder reconstruction.     

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.     

Serine threonine kinase 15 amplification in normal urothelium of cystectomy specimens is no prognostic factor in urothelial carcinoma of the bladder

Predicting the prognosis of patients with bladder carcinoma is demanding, as staging and grading alone do not suffice to make a precise assessment. Thus, the prognostic relevance of various molecular factors was analyzed. It has recently been postulated that gene amplification of serine threonine kinase 15 (STK15) in normal urothelium is of prognostic value in muscle-invasive bladder cancer. The aim of the present study was the validation of these findings.We retrospectively analyzed amplification of STK15 gene in normal urothelium of 68 patients having undergone radical cystectomy for urothelial bladder carcinoma of the bladder at our department between 1998 and 2006 with available paraffin specimens. A tumor micro array (TMA) was constructed, and fluorescence in situ hybridization (FISH) was performed. Signals of chromosome 20 and STK15 gene were counted using fluorescence microscopy.Specimens of 48 patients could be evaluated. The median follow-up was 20 months [2-106 months]; disease-specific death occurred in 7 patients (15%). There was no amplification of STK15 gene in normal urothelium of cystectomy specimens.In contrast to the preceding study, the present data show no STK15 gene amplification in normal urothelium of cystectomy specimens. Prediction of the oncological outcome warrants further research of different markers.     

What's in the pipeline about bladder reconstructive surgery? Some remarks on the state of the art

The fusion of engineering with cell biology and advances in biomaterials may lead to de novo construction of implantable organs. Engineering of neobladder from autologous urothelial and smooth muscle cells cultured on biocompatible, either synthetic or naturally-derived substrates, is now feasible in preclinical studies and may have clinical applicability in the near future. The development of a bioartificial bladder would warrant the prevention of both the metabolic and neoplastic shortcomings of the intestinal neobladder. Two tissue-engineering techniques for bladder reconstruction have been tested on animals: 1) the in vivo technique involves the use of naturally-derived biomaterials for functional native bladder regeneration 2) the in vitro technique involves the establishment of autologous urothelial and smooth muscle cell culture from the host's urinary tract, after which the cells are seeded on the biodegradable matrix-scaffold to create a composite graft that is implanted into the same host for complete histotectonic regeneration. Waiting for the creation of a complete tissue-engineered bladder with a trigone-shaped base, we suggest, in surgical oncology after radical cystectomy, the realization of conduit or continent pouch using tissue-engineered material.     

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.     

Long-Term Oncologic Outcomes after Radical Cystectomy for Bladder Cancer at a Single Institution

The aim of this study was to evaluate our experience using radical cystectomy to treat patients with bladder cancer and to describe the associations between pathologic features and clinical outcomes. All 701 patients who underwent radical cystectomy for bladder cancer were evaluated. The patient population consisted of 623 men and 78 women. The overall 5 and 10 yr recurrence-free survival (RFS) rates were 61.8% and 57.7%, respectively, and the 5 and 10 yr cancer-specific survival (CSS) rates were 70.8% and 65.1%, respectively. Multivariate analysis showed that factors significantly predictive of RFS and CSS included extravesical extension (P = 0.001), lymph node metastasis (P = 0.001), and lymphovascular invasion (P < 0.001 and P = 0.007). The 5 and 10 yr RFS rates for patients with lymph node metastasis were 25.6% and 20.8%, respectively, and the 5 and 10 yr CSS rates were 38.6% and 30.9%, respectively. Adjuvant chemotherapy significantly improved RFS (P = 0.002) and CSS (P = 0.001) in patients with lymph node metastasis. Radical cystectomy provides good survival results in patients with invasive bladder cancer. Pathologic features significantly associated with prognosis include extravesical extension, node metastasis, and lymphovascular invasion. Adjuvant chemotherapy improves survival in patients with advanced stage disease.

Graphical Abstract

相似文献   

宫颈癌术后放疗不同体位膀胱充盈程度对危及器官的影响

目的:探讨宫颈癌术后患者不同体位固定下膀胱充盈对宫颈癌危及器官的剂量学影响。方法:回顾性分析南通市肿瘤医院已经接受容积调强弧形治疗技术放疗的宫颈癌术后患者，通过放疗治疗计划系统对膀胱体积进行测量，分别筛选出行两种固定方法（仰卧位组与俯卧位组）的患者共86例，每组43例。分析两组患者剂量体积直方图中膀胱、小肠、直肠、乙状结肠、结肠的V30、V40及平均受量（Dmean）。通过表格对采集数据生成趋势图并读出每条趋势线R平方值。结果:两组患者的膀胱、小肠、直肠、乙状结肠、结肠的Dmean、V30无统计学意义（P>0.05），俯卧位下膀胱、直肠、乙状结肠、结肠较仰卧位的V40有统计学意义（P<0.05）。俯卧位下膀胱充盈程度与各危及器官的V30、V40、Dmean对应数据拟合度较高，随着膀胱容量的增加，各危及器官的受量降低。结论:宫颈癌治疗行俯卧位对于危及器官的保护优于仰卧位，膀胱体积的增大会使各危及器官照射剂量降低。