回肠代膀胱术和乙状结肠直肠膀胱术在尿流改道术中临床应用效果比较

目的 比较回肠代膀胱术和乙状结肠直肠膀胱术在尿流改道术中的临床应用效果.方法 选择我院2003年至2009年行尿流改道手术患者71例,33例实施回肠代膀胱术,38例实施乙状结肠直肠膀胱术.记录两组患者手术时间、术中出血量;记录两组患者贮尿囊容量;观察两组患者术后6个月主要并发症(主要包括尿失禁、代谢性酸中毒、输尿管返流)发生情况.结果 ①两组患者手术时间、术中出血量比较,差异有统计学意义(P<0.05);两组贮尿囊容量比较,差异无统计学意义(P>0.05);②两组患者尿失禁发生率比较,差异有统计学意义(P<0.05);两组代谢性酸中毒、输尿管返流发生率比较,差异无统计学意义(P>0.05).结论 回肠代膀胱符合生理排尿特点,患者易接受.但是其手术适应范围较小,尿失禁发生率较高.而乙状结肠直肠膀胱术手术过程相对简单,手术适应范围广,尿失禁发生率低.     

根治性膀胱切除中回肠原位新膀胱术与回肠膀胱术治疗肌层浸润性膀胱癌效果比较

目的比较根治性膀胱切除中回肠原位新膀胱术与回肠膀胱术治疗肌层浸润性膀胱癌的效果。方法选取2015-01—2018-07间在郑州大学第一附属医院接受根治性膀胱切除术的100例肌层浸润性膀胱癌患者。按照不同代膀胱术式分为2组,原位新膀胱术组患者55例,回肠膀胱术组45例。比较2组的治疗效果。结果回肠原位新膀胱术组的术中出血量及术后恢复排便时间、胃管保留时间、并发症总发生率、住院时间均低于回肠膀胱术组,差异有统计学意义(P均0.05)。术前2组患者的最大尿流率、膀胱容积、充盈期膀胱压力、最大尿道压、残余尿量差异均无统计学意义(P0.05)。2组术后上述尿流动力学指标均较术前降低,差异有统计学意义(P0.05),但组间差异无统计学意义(P0.05)。回肠原位新膀胱组术后生活质量评分高于回肠膀胱术组,差异有统计学意义(P0.05)。结论根治性膀胱切除中回肠原位新膀胱术与回肠膀胱术治疗肌层浸润性膀胱癌,均有良好效果。但前者术后胃肠道功能恢复较快,并发症总发生率较低,生活质量较高。可作为治疗肌层浸润性膀胱癌的首选术式。     

腹腔镜保留前列腺尖部包膜根治性膀胱切除W形回肠新膀胱术尿控和勃起功能研究

目的探讨腹腔镜下保留前列腺尖部包膜根治性膀胱切除W形原位回肠新膀胱术的临床疗效。 方法回顾性分析2019年1月至2021年12月行腹腔镜根治性膀胱切除W形回肠原位新膀胱术的43例男性膀胱癌患者的临床资料。分为保留前列腺尖部包膜组20例（观察组）和非保留前列腺尖部包膜组23例（对照组）。观察组在距前列腺尖部1.0 cm处切开前列腺包膜,剜除前列腺,保留部分前列腺包膜的腹腔镜膀胱根治切除。对照组采用常规腹腔镜膀胱根治切除。两组W形回肠新膀胱制作方法相同。术后3周拔除导尿管,每３个月定期复查,收集所有患者的临床资料和完整随访信息。 结果所有患者均顺利完成手术。术后随访6~40个月无肿瘤复发。两组患者在术前人口学资料、膀胱肿瘤分期、手术时间、术中出血量、术中并发症、90 d内并发症发生率和术后6个月新膀胱残余尿量差异均无统计学意义（P>0.05）。术后6个月尿控率和勃起功能（IIEF-5评分）实验组优于对照组,日间尿控率分别为85.0%和52.2%（P<0.05）,夜间尿控率分别为65.0%和34.8%（P<0.05）,IIEF-5评分分别为[8（6,9）]分和[3（2,5）]分（P<0.05）。 结论腹腔镜下保留前列腺尖部包膜根治性膀胱切除W形原位回肠新膀胱术有利于尿控和勃起功能保护,不会影响肿瘤控制效果,值得临床推广应用。     

腹腔镜与开放性膀胱全切原位回肠代膀胱术的疗效比较

目的　比较腹腔镜与开放性手术施行膀胱全切除 原位回肠新膀胱手术的临床疗效。　方法　对 1994年 6月至 2004年 9月施行的膀胱全切除 原位回肠新膀胱术 81例患者进行随访,根据手术方法不同分为腹腔镜手术组 (A组, 33例 )和开放性手术组 (B组, 48例 );对两种术式的手术方法、手术时间、术中出血量、术后疗效及并发症进行比较分析。　结果　平均手术时间:A组为 390min,B组为 330min。术中平均出血量:A组 460ml,B组 1200ml。术后肠道功能恢复时间:A组 3~4d,B组 4~5d,两组手术组织切缘均无肿瘤。盆腔淋巴结清扫阳性率:A组 18. 2% ( 6例 ),B组18. 8% (9例)。尿控功能:术后 3~6个月A组的日间尿控率为 93. 9%,夜间尿控率为 87. 9%,B组分别为 90. 5%和 85. 7%。新膀胱尿动力学检查结果:A组的最大尿流率为 (18. 4±6. 1)ml/s,B组为(15. 7±5. 5)ml/s;新膀胱容量、膀胱内压、剩余尿量两组差异无统计学意义。IVU检查及新膀胱造影检查:两组病例均可见输尿管轻度扩张但无明显输尿管梗阻及返流,新膀胱形态大小接近正常膀胱,排空完全。尿道膀胱镜见尿道吻合口通畅,新膀胱内可见输尿管小乳头并有喷尿。术后并发症:A组总并发症发生率为 18. 2%,其中尿瘘 2例,盆腔感染 1例,肠梗阻 2例,新膀胱阴道瘘 1例;B组总并发症发生     

腹腔镜与开放根治性膀胱全切-回肠原位新膀胱术的疗效对比

目的 比较开放及腹腔镜根治性膀胱全切-回肠原位新膀胱术的临床疗效。方法 回顾性分析我院自2010年9月至2014年3月行开放(ORC)及腹腔镜(LRC)根治性膀胱全切-回肠原位新膀胱术患者的资料,其中ORC组13例,LRC组21例。对两组患者的术前基本资料、围术期数据、术后并发症情况、术后控尿情况及肿瘤学随访数据进行对比分析。结果 LRC组较ORC组具有术中出血量少(P=0.013)、术后恢复进食时间短(P=0.001)、住院时间短(P=0.005)的特点。两组在术后并发症发生率方面无明显差异(P=0.725)。所有患者术后切缘均为阴性,两组患者在淋巴结清扫个数(P=0.393)以及淋巴结阳性率(P=0.562)方面无统计学差。中位随访时间28.5个月(8~47个月)。在术后1年内,LRC组与ORC组在日间控尿率(88.2%vs.84.6%,P=0.773)及夜间控尿率(70.6%vs.76.9%,P=0.697)无明显差异。在随访过程中,4例患者发生肿瘤复发或转移,其中盆腔复发2例,脑转移1例,肺转移1例。3例患者死亡。LRC组与ORC组在肿瘤特异性生存率及无复发生存率上无统计学差异(P均>0.05)。结论 与开放手术相比,腹腔镜根治性膀胱全切-回肠原位新膀胱术具有术中出血少、术后恢复快的特点,其术后控尿功能及肿瘤学结果与开放手术疗效相当,因此应作为首选手术方案。     

腹腔镜根治性全膀胱切除+原位回肠新膀胱术对膀胱癌患者的临床疗效及并发症分析

摘 要：目的 比较腹腔镜根治性膀胱全切除+原位回肠新膀胱术与开放手术的临床效果及安全性。方法 选择2010年1月至2015年3月在本院行膀胱全切除+原位回肠新膀胱术的70例患者作为研究对象,其中30例行腹腔镜下手术作为观察组,40例行开放手术作为对照组;对比两组患者围手术期情况、新膀胱功能及并发症发生情况。结果 观察组胃肠道功能恢复时间、术后住院时间明显缩短,术中出血量明显减少,与对照组相比差异具有统计学意义（P＜0.05）,手术时间则明显长于对照组（P＜0.05）;两组患者在控尿率、膀胱内压、膀胱容量、剩余尿量等方面差异无统计学意义（P＞0.05）,观察组最大尿流率显著高于对照组（P＜0.05）。两组患者术后主要并发症有肠梗阻、尿瘘、尿路感染、肺部感染、排尿困难、切口感染等;观察组总并发症发生率为16.7%,显著低于对照组（37.5%）,两组相比差异具有统计学意义（χ2=4.642,P＜0.05）。结论 腹腔镜根治性膀胱全切除+原位回肠新膀胱术具有创伤小、出血少、恢复快、新膀胱功能良好、术后并发生发生率低等优点,值得临床推广。     

根治性膀胱切除回肠去带乙状结肠原位膀胱术(附31例报告)

目的探讨双U形回肠原位膀胱和去带乙状结肠原位脐胱术的疗效。方法31例膀胱癌，全部行根治性膀胱切除术，其中10例行双U形回肠原位膀胱术，21例行盘带乙状结肠腺值膀胱术。结果31例手术时间4．5-7h，平均5．6h，31例随访1—36个月，平均19．5个月，两组病人均控尿良好，3例高氯血症，4例轻度腹泻（均为回肠组）。膀胱造影未见输尿管反流，IVU示左肾盂轻度积水3例，新膀胱容量220-400mL，平均315mL，新膀胱充盈时最大压力2．5-4．9kPa（回肠组）、2．1-5．8kPa（乙状结肠组）。结论双U形回肠和去带乙状结肠均为理想的贮尿囊，操作简单，并发症少，疗效可靠，而去带乙状结肠原值膀胱更接近生理膀胱，很少引起代谢紊乱和腹泻。     

原位回肠和乙状结肠新膀胱尿动力学的比较分析

目的：比较、分析根治性全膀胱术后,原位回肠和乙状结肠新膀胱的尿动力学结果,为选择更为理想的新膀胱提供依据。方法：2002年1月～2009年6月间,将60例浸润性膀胱癌患者随机行根治性全膀胱切除、原位回肠新膀胱术（A组,男29例,女1例,平均54岁）和根治性全膀胱切除、原位乙状结肠新膀胱术（B组,男28例,女2例,平均55岁）。术后18～24个月比较分析两组患者储尿囊及流出道的尿动力学检查结果。结果：储尿囊最大容量、储尿囊最大内压、最大尿流率、剩余尿量、昼尿可控率、夜尿可控率A组分别为（556．0±110．5）ml、（1.695±0．598）kPa、（18．2±2．3）ml／s、（81．3±3．3）ml、90．0％、83．3％;B组分别为（410．2±90．2）ml、（1．784±0．843）kPa、（17．3i2．8）ml／S、（79．3土d．3）ml、86．7％、80．0％。两组储尿囊最大容量差异有统计学意义（P〈0．05）,储尿囊最大内压、剩余尿量、最大尿流率、昼夜尿町控率差异无统计学意义（P〉0．05）。结论两种术式术后均获得较好的控尿和排尿疗效,术者可以根据肠系膜的长短,擅长的手术方式选择新膀胱的方法。     

腹腔镜下膀胱根治性切除-原位回肠新膀胱术:附22例报告

目的探讨腹腔镜下膀胱根治性切除-原位回肠新膀胱术治疗肌层浸润性膀胱癌的手术疗效及并发症。方法回顾性分析惠州市中心人民医院自2005年10月至2013年10月开展腹腔镜下膀胱根治性切除-原位回肠新膀胱术患者的临床资料,22例确诊为浸润性膀胱癌患者,其中男18例,女4例,对手术时间、出血量及随访结果等进行分析。结果平均手术时间为6.5 h,平均出血量为362 ml,无中转开放手术,无围手术期死亡病例,所有患者手术切缘均为阴性。术后随访12~106个月,随访期间死亡7例,其中与肿瘤相关死亡5例。结论腹腔镜下膀胱根治性切除-原位回肠新膀胱术在具有腹腔镜技术的综合医院开展是可行的,其并发症较少及具有较好的新膀胱功能。     

原位回肠新膀胱术与Bricker术的比较及近期并发症探讨

目的 探讨膀胱肿瘤患者膀胱全切除术后行原位回肠新膀胱术及Bricker术（回肠膀胱术）的临床治疗效果及术后近期并发症。方法 分析2001年1月～2007年4月68例膀胱肿瘤患者行膀胱全切术后采用原位回肠新膀胱术31例及Bricker术37例的临床资料，就两种术式手术时间、术中出血量、术后早期并发症发生率、术后平均住院日、再手术率及手术死亡率等指标进行比较分析。结果除平均手术时间原位回肠新膀胱术组（258min）明显长于Bricker术组（212min）外，原位回肠新膀胱术组与Bricker术组在术中出血量（542ml与523m1）、术后早期并发症发生率（16．1％与16．2％）、患者术后平均住院日（23天与20天）、再手术率（3．2％与2．7％）及手术死亡率（均为0）等方面差异无统计学意义（P〉0．05）。结论 原位回肠新膀胱术是膀胱全切术后膀胱替代的理想术式，具有手术安全，手术后早期并发症少，可自主控制排尿，明显提高患者的生活质量。     

原位回肠和乙状结肠尿流改道术临床疗效比较

目的比较原位回肠和乙状结肠尿流改道术的临床疗效。方法回顾性分析1995 -2005年行膀胱癌术后原位回肠尿流改道术96例,乙状结肠尿流改道术68例的患者资料。比较分析2组患者术中术后一般情况、控尿能力、尿动力学结果以及术后储尿囊相关并发症。结果164例患者失访12例(7．3%)。平均随访时间回肠组46(2～86)个月,乙状结肠组42(4～78)个月。2种术式术中失血量、术后控尿效果接近(P＞0．05),但2组手术时间(6．0±0．8 h vs 5．2±0．6 h),术后下床时间(7．8±0．8 d vs 6．4±1．0 d),新膀胱容量(550．0±122．5 ml vs 420．0±80．6 ml)等方面差异有统计学意义(P＜0．05)。原位回肠尿流改道组术后早期及晚期储尿囊相关并发症发生率分别为16．7%、29．2%,均高于乙状结肠组。原位回肠尿流改道组术后储尿囊再发肿瘤3例,乙状结肠组未见发生。结论两种术式术后疗效均良好。原位乙状结肠尿流改道术耗时短、恢复快、术后并发症发生率低,值得优先采用。     

d-Xylose absorption after urinary orthotopic bladder replacement: colon neobladder compared with ileal neobladder

BACKGROUND: To evaluate the digestive and absorptive status using the D-xylose test in patients who underwent radical cystectomy and orthotopic bladder replacement either by colon or ileal segment. METHODS: D-xylose serum levels after an oral load, nutritional status, plasma vitamin B12 levels, and acid-base and electrolyte balances were studied in 18 patients with colon neobladder and 12 patients with ileal neobladder. Mean follow-up period was 51 months. Results of both types of bladder replacement and a healthy control group were compared. RESULTS: Although no significant difference in the changes of plasma levels of D-xylose after oral load was observed between patients with colon neobladder and healthy controls, plasma levels of D-xylose 90 min after oral load in patients with ileal neobladder were significantly lower than those with colon neobladder. In contrast, there was no significant difference in nutritional status, plasma levels of vitamin B12, and acid-base and electrolyte balances between patients with colon and ileal neobladders. CONCLUSION: Despite acceptable nutritional status, intestinal malabsorption might be present in patients with ileal neobladder, as indicated by the plasma levels of D-xylose, while the colon neobladder group showed no significant differences compared with normal controls. Therefore, absorptive and metabolic status should be carefully monitored after ileal neobladder creation.     

Increased urinary 8-hydroxy-2'-deoxyguanosine excretion after ileal neobladder replacement

OBJECTIVES: To examine whether orthotopic neobladder replacement using either ileum or colon segments results in increased oxidative stress, by measuring urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), one of the most commonly used markers for evaluating oxidative DNA damage. PATIENTS, SUBJECTS AND METHODS: Urinary levels of 8-OHdG and creatinine, urine analysis, nutritional status, and acid-base and electrolyte balances, were assessed in 22 patients with an ileal neobladder, 28 with a colon neobladder, 37 with an ileal conduit and 22 healthy volunteers. The results from both types of orthotopic neobladder, the ileal conduit and in the healthy controls were compared. RESULTS: The mean (sd) ratios of urinary 8-OHdG to urinary creatinine in patients with an ileal neobladder, colon neobladder, ileal conduit and in controls were 20.4 (7.8), 15.2 (4.3), 15.9 (5.1) and 15.2 (5.4) ng/mg, respectively. The urinary 8-OHdG ratio in the first group was significantly higher than in the other three groups. Among patients with a neobladder, the urinary 8-OHdG ratio was closely associated with the degree of pyuria, but not age, gender, the interval from surgery, body weight, height, serum creatinine or the degree of metabolic acidosis. CONCLUSIONS: These findings suggest that creating an ileal neobladder caused significantly greater oxidative stress than a colon neobladder, ileal conduit, or that in healthy controls. Therefore, it is recommended to conduct a careful long-term follow-up considering the possible development of malignant disease after urinary diversion, especially by an ileal neobladder.     

肠膀胱腺瘤1例报告并文献复习

目的：分析肠膀胱肿瘤的发病原因和诊治。方法：报告1例膀胱癌根治、直肠代膀胱、结肠造口术后8年肠膀胱发生绒毛状腺瘤伴高级别上皮瘤样变的临床资料,并复习相关文献予以讨论。结果：肠膀胱肿瘤多发生在肠膀胱术后10年,临床表现常为肉眼血尿,肿瘤多生长在输尿管一肠吻合缘,良性肿瘤行肿瘤电切术,预后良好。结论：肠膀胱肿瘤的发展过程中,肠膀胱经历了形态学和分子学的改变,较早诊断可获得较好的疗效,对肠膀胱术后的患者临床上应严密随访。     

Intracorporeal neobladder reconstruction: pressure-flow urodyamic studies in cadaveric orthotopic neobladders

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

? To determine the pressure‐flow characteristics of neobladders created in various configurations that may be constructed intra‐abdominally. Complete intracorporeal neobladder construction has been previously described but is limited due to excessive operative time and the need for an advanced laparoscopic skill set.

MATERIALS AND METHODS

? Four neobladder configurations were constructed, each using 20 cm of human cadaveric small intestine. The standard hand sewn Studer pouch was compared with a circular loop, W‐pouch, and U‐pouch with stapled anastamoses. ? Pressure flow studies were completed using the Aquarius TT UDS system (Laborie Medical Technologies, Toronto, Ontario) and each neobladder was filled to a pressure of 50 cm H2O. Neobladder change in pressure, capacity, and overall compliance were determined.

RESULTS

? The cystometric capacities of the stapled U‐pouch, W‐pouch, Circle pouch, and Studer pouch were 167.3 mL, 177.5 mL, 114 mL, and 145.2 mL respectively. The first increase in intravesical pressure was at 90.3 mL, 103 mL, 50 mL, and 85 mL. ? The greatest compliance of 3.81 mL/cmH2O was demonstrated in the U‐pouch, with the W‐pouch revealing a compliance of 3.44 mL/cmH2O. ? The least compliant neobladder was the circle pouch (2.24 mL/cmH20) followed by the standard Studer pouch (2.94 mL/cmH2O).

CONCLUSION

? The construction of an orthotopic neobladder must not only be technically feasible but maintain adequate capacity and compliance for optimal functioning. Pressure‐flow studies demonstrated equivalent results in alternate neobladder configurations. Additional data is needed to determine feasibility in vivo.     

原位新膀胱术与回肠膀胱术临床效果比较

目的：比较膀胱肿瘤患者膀胱全切术后行原位新膀胱术与回肠膀胱术的临床治疗效果及术后早期并发症。方法：选择我院2000-2009年行根治性膀胱切除术治疗膀胱尿路上皮细胞癌65例患者的临床资料,其中行原位新膀胱术31例,回肠膀胱术34例。比较两组一般情况、围手术期情况（术中失血量、手术时间、肠功能恢复时间、住院天数）以及术后早期并发症等指标。结果：两种术式在术中失血量（1140．32±492．82ml vs 920．91±410．48ml）、手术时间（464．81±79．37min vs 413．32±99．54min）、住院天数（47．68±7．53天vs41．09±8．12天）等方面差异有统计学意义（P〈0．05）。结论：原位新膀胱术较回肠膀胱术虽手术步骤复杂,术中出血较多,但因手术安全,可自主性控制排尿,明显提高患者的生活质量而易于接受,是值得推荐的膀胱替代手术方式,在根治性膀胱切除术中值得优先采用。     

An unusual complication after a cystectomy: A case of iliac artery-neobladder fistula

Iliac artery-neobladder fistula is very rare and only a few cases have been reported. The authors report a case of a 62-year-old man, diagnosed with a CT scan and an angiographic procedure and treated with a vascular endoprothesis placed through a percutaneous femoral access. The important role of early recognition is focussed on.     

回肠新膀胱术60例报告

目的　总结１０ 年来行回肠新膀胱术的手术体会。　方法　对６０ 例行回肠新膀胱术患者进行尿流可控性、尿动力学、影像学、核医学及生化检查,手术并发症及生存情况的随访观察。随诊时间６ ～９６ 个月,平均３ 年。　结果　病人白天均可自控排尿,仅有２ 例夜间尿失控。尿动力学检查显示新膀胱容量为２５０ ～４００ｍｌ（ 平均３００ｍｌ） ,膀胱充盈时最大内压１５ ～２５ｃｍＨ２Ｏ（ 平均２０ｃｍ Ｈ２Ｏ） ,排尿膀胱压力为５０ ～７０ｃｍ Ｈ２Ｏ（ 平均５６ｃｍ Ｈ２Ｏ） ,平均最大尿流率１６ｍｌ／ｓ,剩余尿为０ ～１２０ｍｌ（ 平均２０ｍｌ） 。影像学检查仅发现２ 例上尿路轻度扩张,肾功能均正常,无电解质紊乱现象,肾图无梗阻。再次手术修补尿瘘２ 例,肾盂输尿管轻度扩张２ 例,围手术期死亡１ 例。肿瘤转移死亡１２ 例,尿道肿瘤复发１ 例,与肿瘤无关死亡３ 例。　结论　对于肿瘤未侵犯前列腺或尿道的膀胱肿瘤病人和结核性挛缩小膀胱的病人,回肠新膀胱是一种低并发症的膀胱替代手术方法。     

Ileal orthotopic neobladder in women: The first experiences from Turkey and our modifications

The lower urinary tract reconstruction with an ileal neobladder in woman is not very often but has been recently introduced centers. We report 8 female patients with ileal orthotopic neobladders after cystectomy. Patients and methods: Between 1995 to 1999, 7 female patients with organ confined invasive bladder cancer and 1 female patient with severely contracted bladder secondary to tuberculosis were operated. While standard radical cystectomy was done in 7 patients with bladder cancer, only simple cystectomy was performed in patient with contracted bladder. Detubularized ileal W-neobladder with antirefluxive ureteroileal reimplantation were used as a procedure and reservoirs are connected to the proximal urethra in all patients. Cystoscopy and biopsy was done routinly in the bladder neck and there were no tumour and CIS in any patient. Results: The mean age was 65.4 years (53–70) and the mean postoperative follow-up time was 31.8 months (6–48). There was no perioperative or early postoperative (first one month) mortality. Early postoperative complications included acute renal failure in 1 patient (12.5%), deep vein thrombosis in 1 patient (12.5%) and leakage from the pouch in 2 patients (25%). In one patient (12.5%), ileo-pouchal fistula was seen in sixth month and reoperated. Although there was not hypercontinence, one patient (12.5%) had totally incontinence. All other patients had normal micturition and no residual urine. Urethral recurrence was not seen in this postoperative follow-up period but pelvic recurrence and then distant metastases were found in one case (12.5%). Conclusions: The results of ileal orthtopic neobladder after radical or simple cystectomy in appropriate female patients are satisfactory. But certainly, we need the more experiences and studies about this subject. This revised version was published online in September 2006 with corrections to the Cover Date.