保留前列腺包膜的膀胱全切除-原位回肠新膀胱术

目的探讨保留前列腺包膜的膀胱根治性切除一原位回肠新膀胱术的手术方法及疗效。方法2002年5月至2008年9月，对35例浸润性膀胱癌患者施行了保留前列腺包膜的膀胱根治性切除-原位回肠新膀胱术，其中开放手术22例，腹腔镜手术13例。术中保留患者的前列腺包膜、精囊、输精管、神经血管束。术后对患者进行定期随访，了解患者的生活质量、排尿情况，并检测患者的残余尿量、新膀胱压力及性功能情况等。结果全部患者均顺利完成保留前列腺包膜和勃起神经的膀胱根治性切除-原位回肠新膀胱术。其中开放手术时间为210～330min，平均271min；术中出血200-800ml，平均460ml。腹腔镜手术时间为210-420min，平均343min；术中出血80-800ml，平均377ml。术后3个月IVU及代膀胱造影检查，显示双肾显影良好，无输尿管返流及梗阻，代膀胱充盈良好，容量约250-350ml。术后6个月随访，所有患者均能自行排尿，2例患者有夜间尿失禁。术后71．4％（20／28）的患者保留了阴茎勃起功能。无患者出现尿道残端或前列腺包膜肿瘤复发，有2例发生盆腔淋巴结转移，1例骨转移。结论保留前列腺包膜的膀胱根治性切除术与标准的膀胱前列腺根治性切除术相比，具有操作简单、控尿效果好、可保留勃起神经等特点，适用于对性功能要求较强、肿瘤未累及膀胱颈及前列腺的较年轻的患者。然而，其肿瘤控制效果坏有待于讲一彤观察．

Prostatic capsule sparing cystectomy with orthotopic ileal neobladder-preliminary reports

Objective To present our initial experience and results of the prostatic capsule sparing radical cystectomy with orthotopic ileal neobladder. Methods From May 2002 to September 2008,we performed prostatic capsule sparing radical cystectomy with orthotopic ileal neobladder for 35 bladder carcinoma cases, 22 of whom were performed by open surgery,and 13 were performed by laparoscopy. The seminal vesicle, vas deference, and prostatic capsule were preserved. All patients were followed up and perioperative data, urodynamics analysis, residual urine volume, vesical pres- sure, the recurrence of tumor and sexual functive were recorded. Results All the operation were finished successfully. The operative time and the blood loss in the open surgery group were 271 min （210-330 rain） and 460 ml （200-800 ml） respectively,while 343 min （210-420 rain） and 377 ml （80- 800 ml） in the laparoscopic surgery group. The volume of neobladder was 250-350 ml and the position and shape of neobladder were similar to original one under the cystourethrography. All the patients achieved urinary continence in three months postoperatively, 2 cases had occasional night-time incontinence. 71. 4% cases preserved potence after surgery. No case had tumor recurrence in urethral stump or prostatic capsule, but 2 cases had pelvic lymph node metastases, 1 case had hone metastasis. Conclusions The prostatic capsule sparing radical cystectomy with orthotopic ileal neobladder is a simple, effective procedure with the advantages of preserving erectile function. And it could be selectively applied to the younger patients with active sexual function and without tumor invasion of prostate and urethra. However,the long term follow up is needed for tumor control.