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。

Clinical Application of Cystectomy and Roux-y Sigmoidocolic Neobladder in Female Bladder Carcinoma

Objective： To evaluate clinical effects of cystectomy and Roux-y sigmoidocolic neobladder in the treatment of female invasive bladder carcinoma. Methods：12 female patients with bladder cancer received eystectomy and Roux-y sigmoidocolic neobladder that was constructed by cutting sigmoid colon at 20 cm above pelvic peritoneal reflexion, removing the mesentery of the distal end of sigmoid colon, and then performing a ＂Y＂ shape of end-to-side anastomosis of the proximal end of sigmoid colon and rectum. Results：During a fol- low-up period of 3 -96 months （mean 36 months） , the tumors did not relapse. The average functional capaeity of neobladder was 300 ml within immediate postoperative period ,405 ml at 3 months and 456 ml at 12 months, respectively. The postoperative urinary dynamics showed that the filling pressure was （39.2 ± 10.8 ） cm H2O, the maximum flow rate was（34.7 ±8.9）ml/s, the post-voiding residual was 0 ml. The urography on 7 patients in 3 years after operations displayed that the profiles of neobladder were well, without ureteric backstreaming and expansion of upper urinary tract were observed. Conclusions：Treating female invasive bladder carcinoma with cystectomy and Roux-y sigmoidocolic neobladder has many advantages, including good curative effect, less complication, low recurrence rate of tumor, satisfactory function of mieturition after the operations.