膀胱全切后改良肠道原位新膀胱下尿路功能性重建(附15例疗效分析)

背景与目的：膀胱全切后患者的生活质量受尿流改道方式影响,可控性或非可控性尿流改道后患者不能自主排尿、生活质量差;而肠道原位新膀胱术后患者可自主排尿,生活质量改善,但有排空不良和控尿不全等问题。本文报告改良肠道原位新膀胱术在膀胱全切后下尿路功能性重建中的经验。方法：对15例局部浸润性膀胱癌患者在根治性膀胱切除后利用改良肠道原位新膀胱术（回肠新膀胱3例,乙状结肠新膀胱12例）做下尿路功能性重建。术后随访3-30个月（其中9例随访超过16个月）,对这些患者术后新膀胱功能、控尿和排尿功能、性功能、上尿路形态和功能、血电解质和生活质量进行评价。结果：全部患者自主排尿,无需导尿。13例患者昼夜完全控尿;1例患者白天控尿良好,夜间有少量漏尿;另1例女性患者有中度张力性尿失禁。膀胱容量240-640ml,残余尿量0-250ml。全部患者总肾功能正常,14例血电解质正常;慢性代谢性酸中毒和输尿管扩张各1例。9例男性患者保留性功能。13例患者恢复工作。全部患者对新膀胱功能满意。结论：改良肠道原位新膀胱术后下尿路的控尿和排尿功能良好,是目前根治性膀胱切除后理想的下尿路重建方法。

Modified intestinal in situ neobladder in functional reconstruction of lower urinary tract after radical cystectomy: report of 15 cases

BACKGROUND & OBJECTIVE: Quality of life (QOL) in the patients who are performed radical cystectomy is affected by the methods of urinary diversion. The patients with continent or non-continent urinary diversion could not void by themselves and their QOL was poor. However, the intestinal neobladder in situ could provide the patients with good voiding and improve QOL. Unfortunately, some degree of poor empty and incontinence would occur in these patients. The aim of this paper was to report the authors' experience of modified intestinal in situ neobladder in reconstructing the lower urinary tract after radical cystectomy. METHODS: Reconstruction of the lower urinary tract using modified sigmoid neobladder (in 12 patients) and modified ileal neobladder (in 3 patients) was carried out in 15 patients (male 14, female 1; age 33-68 years, mean 53 years) who underwent radical cystectomy for invasive bladder cancer. The patients were followed up for 3-30 months. Nine of them were followed up for more than 16 months. Clinical outcome of these patients including the function of the neobladder, urinary function, sexual status, renal function, serum electrolytes, and QOL was evaluated. RESULTS: All patients voided well by themselves and did not need self-catheterization. Thirteen patients were continent in daytime and night-time. One patient was continent in daytime, but had mild incontinence at night. A female patient had moderate stress incontinence. The capacity of the neobladder was 240-640 ml and the residual volume was 0-250 ml. Renal function was normal in all patients. Serum electrolytes were normal in 14 patients. Metabolic acidosis and unilateral ureteral dilation was encountered in one patient respectively. Nine male patients restored sexual function and 13 patients came back to work. All patients felt satisfied with the function of the neobladder. CONCLUSION: Satisfactory urinary continence and voiding function was achieved with modified intestinal neobladder, which was believed an ideal procedure for lower urinary tract reconstruction after radical cystectomy.