根治性膀胱切除术联合乙状结肠原位新膀胱术治疗浸润性膀胱尿路上皮癌的临床应用(附16例报告)

目的: 探讨根治性膀胱切除术联合乙状结肠原位新膀胱术治疗浸润性膀胱尿路上皮癌的临床疗效。方法: 浸润性膀胱癌患者16例,全部为男性患者。年龄53~75岁,平均年龄63岁。均采用根治性膀胱切除术联合乙状结肠原位新膀胱术治疗。结果: 16例患者住院时间37~62d,平均51d。平均术后住院时间43d。随访5个月~6年,平均26个月。患者血肌酐(Cr)、尿素氮(BUN)水平均正常,未出现酸中毒。膀胱造影未出现单侧输尿管返流。白天可自控排尿14例(87.5%),夜间尿失禁6例(37.5%),皆可通过夜间唤醒控制。新膀胱容量245~380 mL(平均316 mL),新膀胱充盈时最大压力28~57 cmH₂O (平均39cm H₂O,1 cm H₂O=0.098 kPa)。结论: 根治性膀胱切除术联合乙状结肠原位新膀胱术治疗浸润性膀胱尿路上皮癌术后无严重并发症,临床疗效可靠,患者原位排尿,生活质量较高,值得临床推广应用。

Clinical application of sigmoid orthotopic neobladder after radical cystectomy in treatment of invasive bladder cancer:A report of 1 6 cases

Objective:To investigate the clinlic therapeutic effect of sigmoid orthotopic neobladder after radical cystectomy in the treatment of invasive bladder cancer.Methods:1 6 patients with invasive bladder cancer (all males;age range from 53 to 75 years)were admitted and underwent radical cystectomy and sigmoid orthotopic neobladder.Results:Sixteen patients were hospitalized for 37 to 62 d,with an average of 51 d.All patients were followed up for a mean of 26 months (range from 5 months to 6 years).The serum creatinine (Cr)and blood urea nitrogen (BUN)levels were both in the normal range and there was no acidosis in all the cases. No case had unilateral ureteral urine reflux during cystography. Of the 16 patients 14 cases (87.5%) achieved continence during daytime;6 cases (37.5%) were incontinent at night, but all of them could control urination by being woken up at night.The capacity of the neobladder was 245 to 380 mL with an average of 316 mL and the maximal pressure of the neobladder during filling was 28 to 57 cm H2 O (1 cm H2 O =0.098 kPa)with an average of 39 cm H2 O.Conclusion:As an operation the sigmoid orthotopic neobladder can be performed easily without serious postoperative complications and has more reliable results. This operation may be generally applied in clinical practice.