原位回肠代膀胱术的疗效观察（附25例报告）

目的：观察7年来行原位回肠代膀胱术的治疗效果。方法：对25例男性膀胱癌患者行膀胱全切回肠代膀胱术。结果：25例患者中有24例获得随访，随访时间2－84个月，平均84个月。手术时间平均240min，输血量平均550ml，手术并发症少，23例患者白天可控制排尿，其中14例夜间自控排尿。3例有肾脏或输尿管积水，2例肾功能异常。膀胱排尿造影均未发现输尿管反流。血生化检查除2例发现低血钾外，其余血电解质均在正常范围。未发现肠膀胱或尿道肿瘤复发。结论：原位回肠代膀胱术是值得选择的尿流改道方式。

Ileal orthotopic neobladder(Report of 25 cases)

To present a 7 year experience with ileal orthotopic neobladders. Methods:An neobled der was constructed using an ileal segment with a“W” type. 23 of 25 cases of ileal neobladders have been fol lowed up for 2-to 84 months with a mean of 24 months. Results :Operating time ranged from 150 to 310 minutes with a mean of 240 minutes. 1 died of cancer metastasis. All patients were satisfactory with the operation except 3 cases. 23 patients achieved excellent daytime continent, while only 14 had nighttime continent. The maximal effective capacity of the neobladder was 200 to 550 ml with a mean of 310 ml. 11 patients have taken place in guinal hernia and 1 suffered from incision hernia. 3 cases had mild renal dysfunction. 2 patients had hypokalcemi a. On IVU examination, failure of imaging of unilateral kidney occurred in 2 patients. 3 cases of patients had u nilateral ureter extension or hydronephrosis. 5 cases had their residual urine volume over 50 ml, and 1 case had neobladder stone discovered by BUS. Voiding cystography revealed no ureteral reflux. No patient suffered from neobladder or urethral recurrence. Conclusion:An ileal orthotopic neobladder offers an attractive alternative to a bladder substitute when cystectomy is required.