两种原位新膀胱术相关临床疗效及并发症的观察比较

目的:评价原位回肠新膀胱(IN)和乙状结肠新膀胱(SN)术后的临床疗效,观察相关并发症.方法:65例膀胱癌患者,IN 40例,SN 25例.结果:65例患者平均随访18个月.术后6个月,IN组最大贮尿量较SN组多;膀胱充盈压及膀胱排尿压均较SN组低.IN组白天尿控满意率为87.5%,SN组为92.0%;SN组夜间尿控满意率为48.0%,IN组为65.0%,差异均无统计学意义.术后并发症:漏尿4例,排尿困难2例,术后感染2例,粘液堵塞2例,尿失禁1例,肠梗阻1例;勃起功能障碍6例,吻合口狭窄4例,慢性尿潴留3例,上尿路积水2例,盆腔转移1例.结论:回肠新膀胱可以达到足够的贮尿量和较好的尿流动力学改变,控尿满意.回肠是优先选择的新膀胱材料.

Clinical efficacy of the two orthotopic neobladder and observation of the related complications of new-bladder

Objective:To evaluate clinical efficacy among patients who had gone orthotopic neobladder substitu-tion with sigmoid or ileal segments,observe the related complications.Methods:65 cases of bladder urothelial carci-noma,Forty patients with an ileal neobladder(IN) and 25 patients were received a sigmoid neobladder(SN).Results:Complete follow-up was performed in 65 cases 18 months averagely postoperatively.The patients were examined after 6 months.The average reservoir capacity of IN was higher than of SN,the bladder filling pressure and urination bladder pressure were lower than of SN.Daytime continence was 87.5%in IN group and 92.0%in SN group,night-time continence was 65.0%in IN group and 48.0%in SN group.Complications including urine leakage in 4 cases,void dysfunctions in 2 cases,wound infectious in 2 cases,mucus jammed the urethra in 2 cases,urinary incontinence in 1 case,bowel obstruction in 1 case;ED in 6 cases,anastomosis stricture in 4 cases,chronic urinary retention in 3 cases,hydronephrosis in 2 cases,pelvic metastases in 1 case.Conclusion:A neobladder constructed from detubular-ized ileum achieves adequate reservoir capacity,accepted urodynamics with a satisfactory continence rate.Ileum are ideal bladder substitutions.