保留性功能全膀胱切除原位回肠新膀胱术(附19例报告)

目的探讨保留勃起和射精功能的全膀胱切除术对浸润性膀胱癌的疗效。方法收集2000年1月～2006年6月膀胱移行细胞癌19例，男性，平均年龄50.9岁，为保留性功能，改善控尿，行改良根治性全膀胱切除原位回肠新膀胱术，保留精囊、输精管、双侧神经血管束及大部分前列腺包膜，随访观察手术效果和生活质量。结果术后病理报告T2aN0M013例，T2bN0M06例。平均随访39个月（6～78个月），死亡率0，均未发现局部及远处转移;平均手术时间5h，平均出血400ml;白天控尿率100%（19/19），夜间尿失禁10.5%（2/19）;全部患者均保留勃起及逆行射精功能，IIEF-5平均22分;新膀胱储尿囊容量350～480ml，充盈压13～25cmH2O，残余尿量10～60ml。结论对有选择的病例采用保留性功能的全膀胱切除-原位回肠新膀胱术可以更好的保留阴茎勃起射精及控尿功能。

Sexuality preserving cystectomy and neobladder for the treatment of bladder carcinoma in 19 patients

Objective To evaluate the oncological outcome and functional results of our sexuality preserving cystectomy and neobladder in bladder carcinoma.Methods Between January 2000 and June 2006,19 patients were selected for a sexuality preserving cystectomy with orthotopic urinary diversion.Average patient age was 50.9 years.During the operation,the vasa deferens,seminal vesicles,prostatic capsule and neurovascular bundles were preserved.A complete clinical evaluation was performed in the followup.R e s u l t s P o s t operative pathological stage was T2aN0M0 in 13 cases and T2bN0M0 in 6 cases,and mean follow-up was 39 months.Mortality was 0.No local or distant recurrences were observed and all the patients were alive.The mean operating time was 5 hours;the mean blood loss was 400ml.Complete daytime continence was reached in all patients(100%)and nighttime incontinence was found in 2 patients(10.5%).Normal erectile function was preserved in all patients(100%);the mean IIEF score was 22,but all patients had retrograde ejaculation.The mean capacity of the neobladder was 420ml.Cystometry showed the filling capacity pressure was 21cmH2O,and the mean residual volume was 45ml.Conclusion Sexuality preserving cystectomy and neobladder in selected patients with bladder cancer is feasible.Functional results with regard to erectile function and urinary continence are excellent.