原位回肠和乙状结肠新膀胱尿动力学的比较分析

目的：比较、分析根治性全膀胱术后，原位回肠和乙状结肠新膀胱的尿动力学结果，为选择更为理想的新膀胱提供依据。方法：2002年1月～2009年6月间，将60例浸润性膀胱癌患者随机行根治性全膀胱切除、原位回肠新膀胱术（A组，男29例，女1例，平均54岁）和根治性全膀胱切除、原位乙状结肠新膀胱术（B组，男28例，女2例，平均55岁）。术后18～24个月比较分析两组患者储尿囊及流出道的尿动力学检查结果。结果：储尿囊最大容量、储尿囊最大内压、最大尿流率、剩余尿量、昼尿可控率、夜尿可控率A组分别为（556．0±110．5）ml、（1.695±0．598）kPa、（18．2±2．3）ml／s、（81．3±3．3）ml、90．0％、83．3％；B组分别为（410．2±90．2）ml、（1．784±0．843）kPa、（17．3i2．8）ml／S、（79．3土d．3）ml、86．7％、80．0％。两组储尿囊最大容量差异有统计学意义（P〈0．05），储尿囊最大内压、剩余尿量、最大尿流率、昼夜尿町控率差异无统计学意义（P〉0．05）。结论两种术式术后均获得较好的控尿和排尿疗效，术者可以根据肠系膜的长短，擅长的手术方式选择新膀胱的方法。

Comparison of Orthotopic Sigmoid and Ileal Neobladders: Continence and Urodynamic Parameters

Objective:The objective this of the study was to compare continence rates and urodynamic parameters among patients who had undergone orthotopic bladder substitution with sigmoid or ileal segments and to provide evidence of ideal neohladdcr.Methods:Between January 2002 and June 2009,60 patients with invasive bladder cancer were randomized into two groups.Group A comprised 30 patients who had radical cystectomy and reconstruction with an ileal orthotopic neobladder(median age 54 years,29 men and 1 women) and group B included 30 who had an sigmoid orthotopic neobladder substitution after radical cystectomy(median age 55 years,28 men and 2 women).Sixty patients agreed to postoperative urodynamic evaluation at a median time after surgery of 18-24 months,respectively.Continence and urodynamic parameters were compared in both groups.Results:The maximum capacity,he maximum intravesical pressure,the maximum flow rate,post-void residual(PVR),diurnal and nocturnal continence rate were(556.0±110.5) ml、l.695±0.598 kPa、(18.2±2.3)ml/s、(81.3±3.3) ml、90.0%、83.3%in group A and(410.2±90.2)ml,(1.784±0.843)kPa、(17.3±2.8)ml/s、(79.3±4.3)ml、86.7%、80.0%in group B,respectively.The maximum capacity were significantly different between the two groups.The maximum flow.PVR,the maximum intravesical pressure,diurnal and nocturnal continence rate were similar between the two groups.Conclusions:Orthotopic sigmoid and ileal neobladder both can achieve satisfactory continence and micturition.Surgeon preference,ease of construction and length of mesentery are among the factors that must be considered when choosing between them.