改良膀胱全切正位可控W形回肠代膀胱术(附10例报告)

目的:探讨改良膀胱全切正位可控W形回肠代膀胱术的疗效。方法:对10例膀胱癌患者采用改良膀胱全切正位可控W形回肠代膀胱术。膀胱全切时不切断耻骨前列腺韧带,切断前列腺尖部时紧贴精阜近端,并采用电刀紧贴膀胱及前列腺处理膀胱侧后韧带和前列腺侧韧带。截取末段回肠,排列成W形,褥式缝合制作贮尿袋,输尿管以乳头法种植。结果:10例手术时间平均240min,术中平均出血量600ml,术后随访12~24个月,平均16个月,日间控尿良好10人,夜间控尿良好9人,9例患者性功能恢复,未见一例尿失禁。结论:改良膀胱全切正位可控W形回肠代膀胱术手术时间短,操作简单,术中出血少,并发症少,术后患者控尿效果好,尿失禁发生率低,性功能恢复良好。

A modified technique of total cystectomy and ileal neobladder(Report of 10 cases)

Objective:To present a modified technique of toal cystectomy and ileal neobladder.Methods:Cystectomy and ileal neobladder were performed in 10 male patients.When the bladder were dissected,puboprostatic ligament was preserved.The apex of the prostate was divided just distal to proximal end of seminal colliculus and using electrotome breaked vescle lateral ligament and prostate lateral ligament near the bladder and prostate.The reservior was constructed by using a 40 cm ileal segment that was opened along its antimesenteric border and then arranged into a W shape.The wall of ileal pouch was created by side-to-side blanket suture of the incised ileum.The ureters were implanted with antireflux nipple.Results:The operation took 200 to 320 minutes with a mean of 240 minutes.The intraoperative blood loss was 250 to 1200 ml with a mean of 600 ml.Ten patients have achieved excellent daytime continence,whereas 9 patients had nighttime continence.Sexual function recovered in 9 patients.Conclusions:The modified total cystectomy and ileal neobladder has the advantages of less operating time,less blood loss,less complications.