女性保留内生殖器膀胱全切原位回肠新膀胱尿流改道术的临床疗效

目的:探讨女性保留内生殖器膀胱全切患者行原位回肠新膀胱尿流改道术的临床疗效。方法:回顾性分析我院2005年7月~2012年5月48例女性膀胱肿瘤患者的临床资料,均采取保留内生殖器的膀胱全切术并行原位回肠新膀胱尿流改道术。48例患者中移行细胞癌46例,腺癌2例;原发肿瘤32例,复发性肿瘤16例;多发性非肌层侵犯肿瘤17例,肌层浸润性膀胱肿瘤31例。结果:48例患者的平均手术时间260(210~360)min,平均输血量280(0~1200)ml。术后47例患者获得随访,随访6~84个月,平均36个月。术后12个月白天控尿率为97.9%(46/47),夜间控尿率为93.6%(44/47)。新膀胱尿道吻合口漏3例。术后6个月IVU检查输尿管狭窄2例。无子宫、子宫附件及阴道转移复发。结论:对于符合适应证的女性膀胱癌患者,保留内生殖器、阴道前壁、自主神经及完整尿道,行膀胱全切并行原位回肠新膀胱尿流改道术,临床疗效满意,术后患者生活质量高,可作为广泛开展的术式。

Clinical effects of reproductive organs sparing in female radical cystectomy with ileal orthotopic neobladder replacement

Objective：To summarize the therapeutic effects of reproductive organs sparing in female radical cystectomy with ileal orthotopic neobladder replacement.Method：The clinical data of 48 cases of bladder carcinoma who underwent radical cystectomy and orthotopic ileal neobladder from July 2005 to May 2012 were analyzed retrospectively.Pathology showed transitional cell carcinoma could be found in 46 cases,bladder adenocarcinoma could be seeen in two cases.Of them,32 cases were primary tumors and 16 were recurrent ones.Seventeen cases were multifocal non-muscle invasive tumors and 31 cases were muscle invasive tumors.Result：The mean operative time was 260（range,210-360）min,and the mean blood transfusion was 280（range,0-1200）ml.All patients except one were followed-up for a mean period of 36（range,6-84）months.At 12 months after surgery the continence rate was 97.9%（46/47）during the daytime and 93.6%（44/47）at night.Three patients suffered from neobladder urethra anastomotic fistula.At six mouths IVU showed two patients were found ureterostenosis.No carcinoma plant metastasis and recurrence occurred.Conclusion：Uterus,ovary,appendages,vagina,autonomic nerve and complete urethra can be reserved in radical cystectomy for female patients with bladder tumour.Total cystectomy with ileal orthotopic neobladder replacement is beneficial to female patients.The results of reproductive organs sparing in female radical cystectomy with ileal orthotopic neobladder replacement are satisfactory and this surgical technique can be used widely.