原位去带盲升结肠膀胱的尿动力学分析

目的:分析原位去带盲升结肠膀胱的尿控效果。方法:对13例全膀胱切除原位去带盲升结肠膀胱患者行尿动力学检查,测定尿流率、残余尿、储尿期去带盲升结肠膀胱的顺应性、稳定性、膀胱感觉、膀胱容量及排尿期去带盲升结肠膀胱收缩力。结果:13例随访6～19个月,平均15个月,白天均完全可控,10例夜间完全可控,溢尿3例。最大尿流率14.5～26.5mL/s,平均18.6mL/s。残余尿0～55mL,平均25.5mL。顺应性20～30mL/cmH2O,平均27.3mL/cmH2O。储尿期去带盲升结肠膀胱较少出现无抑制性收缩,压力0～20cmH2O,平均13.3cmH2O。去带盲升结肠膀胱感觉减退,无明显最初排尿感、正常排尿感。去带盲升结肠膀胱容量为290～550mL,平均355.7mL。去带盲升结肠膀胱内压力12.47～34.50cmH2O,平均24.54cmH2O。排尿期均为腹压协助排尿。结论:原位去带盲升结肠膀胱压力低、控制排尿满意,是一种理想的尿分流手术。

Urodynamic evaluation of detina ceacal-rescending colon orthotopic neobladder

Objective：To assess the continence outcomes of detina ceacal-rescending colon orthotopic neobladder.Methods：Urodynamic studies were carried out in 13 patients that underwent radical cycestomy and detina ceacal-rescending colon orthotopic neobladder.The continence status,maximum urinary flow rate,postvoid residual,compliance,stability,sensation,capacity,voiding cystometry were detected.Results：Average follow up of 15 months ranging from 6 to 19 months showed all 13 cases were completely continent during day time while only 10 of them got complete continence at night.Only 3 cases suffered from nocturnal incontinence.The mean maximum urinary flow rate was 18.6 mL/s（14.5-26.5 mL/s）,mean postvoid residual was 25.5 mL（0-55 mL）,mean compliance was 27.3 mL/cmH2O（20-30 mL/cmH2O）,mean capacity was 355.7 mL（290-550 mL）,and the mean pressure of filling phase was 24.54 cmH2O（12.47-34.50 cmH2O）（1cmH2O=0.098 kPa）.The neobladder stability was in good condition,but the neobladder sensationg and contraction was decreased.Conclusion：Detina ceacal-rescending colon orthotopic neobladder shows good continence outcomes,low pressure from the pouch and is highly recommended.