Carney Ⅱ式原位回肠膀胱术的远期疗效分析

目的 评价CarneyⅡ式原位回肠膀胱术后患者的远期疗效.方法 膀胱移行细胞癌行根治性膀胱切除CarneyⅡ式原位回肠膀胱术患者33例.采用美国癌症患者生命质量量表(FACT)和国际前列腺症状评分(IPSS)衡量患者术后生活质量,采用膀胱容量、最大尿流率、残余尿量,充盈期膀胱压力等尿动力学结果评估回肠膀胱功能.结果 33例患者中,术后10个月因肿瘤尿道复发死亡1例,失访2例.30例患者随访12～60个月.术后尿动力学检查回肠膀胱容量(380±65)ml、最大尿流率(12.6±2.3)ml/s、残余尿量(25±11)ml,充盈期膀胱压力明显低于尿道闭合压[(20.4±8.7)cm H2O(1 cm H2O=0.098 kPa))与(57.2±10.5)cm H2O,P<0.05].并发肾功能不全1例、尿瘘2例.术后1年28例患者白天控尿均满意,夜间控尿满意26例.FACT评分为(110.5±16.0)分,IPSS评分(14.5±4.2)分.结论 CarnyⅡ式原位回肠膀胱术式是一种效果良好、并发症较低的尿流改道术,有较好的临床应用价值.

Long-term outcome of orthotopic ileal neobladder (Camey Ⅱ) in the treatment of bladder cancer

Objective To report the long-term follow-up results on treating bladder transitional cell carcinoma with orthotropic ileal neobladder after radical cystectomy.Methods Thirty-three male patients with a mean age of 64 years were subjected to Carney Ⅱ orthotropic ileal neobladder oper-ation after cystectomy.The entire length of ileum was opened along the antimesenteric border,placed into a transverse U shape,and sutured with a running suture.The bottom of the U shape was anasto-mosed with urethra to reconstruct the urinary continuity.The perioperation mortality,complications,urinary continence,renal function,image findings,and urodynamic examination were all retrospec-tively investigated.The quality of life was evaluated using the Functional Assessment of Cancer Ther-apy-Bladder(FATC) and International Prostate Symptom Score (IPSS).Results Thirty patients were followed up for 12-60 months.Urodynamics was carried out after oporation.The average ca-pacity of the urinary reservoir,the peak flow rate and postvoid residual were (380±65) ml,(12.6±2.3) ml/s and (25±11) ml,respectively.But the intra-reservoir pressure was significant lower than the intra-urethra pressure(20.4±8.7 cm H2O vs.57.2±10.5 cm H2O).Twenty-eight patients had a satisfactory daytime urinary continence and 26 patients had a satisfactory nocturnal urinary continence.The total FACT was 110.5±16.0 and IPSS was 14.5±4.2.Conclusion CamyⅡ ileal neobladder is a satisfactory method for treatment of invasive bladder cancer after radical cystectomy; it has few com-plication and is clinically valuable.