女性原位尿流改道的临床研究

目的　总结女性膀胱全切患者行原位尿流改道的临床疗效。　方法　回顾性分析1995年9月至2003年12月34例女性膀胱全切、原位尿流改道患者的临床资料。34例患者,年龄53~64岁,平均58岁。其中移行细胞癌30例,腺癌3例,鳞状上皮癌1例。原发肿瘤30例,复发肿瘤4例。34例患者均行膀胱全切,其中24例保留自主神经。所有患者均截取末段回肠,行回肠代膀胱。术后随访观察临床效果。　结果　34例手术时间平均360min(280~420min),输血量平均600ml(300~1000ml)。术后30例获随访,随访6~108个月,平均61个月。术后6个月昼夜控尿率分别为90% (27 /30)和86% (26 /30)。一次性排空膀胱23例, 2例排尿可控过度,需定时导尿,另5例需采用手压下腹部排空新膀胱。23例行尿动力检查结果显示:贮尿囊容量300~520ml,充盈期囊内压<23cmH2O(6~23cmH2O, 1cmH2O=0. 098kPa),最大尿道压35 ~70cmH2O,功能性尿道长2. 6~3. 5cm,剩余尿量0~38ml。IVU检查贮尿囊球形,无输尿管狭窄,轻度输尿管返流1例,肾盂输尿管轻度扩张1例。血电解质和肾功能正常.无肠膀胱或尿道残端复发者。　结论　女性膀胱癌患者行原位尿流改道可获得满意的临床效果,可作为该类患者的首选治疗方法。

Orthotopic urinary diversion in women

Objective To investigate the therapeutic effects of orthotopic urinary diversion in women. Methods From September 1995 to December 2003,34 female patients (mean age,58 years;range,53-64 years) with bladder cancer were included.Of them,30 cases were of primary tumors and 4,of recurrent ones.Pathology showed transitional cell carcinoma in 30 cases,bladder adenocarcinoma in 3 and squamous cell carcinoma in 1.Radical cystectomy was performed in all the 34 cases;and the technique of cystectomy with nerve-sparing was performed in 24 of them. Intraoperative frozen section of the distal urethra surgical margin showed no evidence of tumor,and ileal neobladder was formed in all.The clinical therapeutic effects were analyzed retrospectively. Results The mean operative time was 360 min(range,280-420 min),and mean blood transfusion was 600 ml(range,300-1000 ml).Thirty cases were followed up for a mean of 61 months(range,6-108 months).At 6 months after surgery the continence rate was 90%(27/30) during the day and 86%(26/30) at night.Twenty-three cases could empty the neobladder one time and 2 needed intermittent catheterization due to hyper-continence; the other 5 needed pushing the abdomen to empty the neobladder. Twenty-three patients had good urodynamic findings;the vesical capacity ranged 300-520 ml and maximum intravesical pressure were<23 cm H 2O(range,6-23 cm H 2O,1 cm H 2O=0.098 kPa).The maximum urethral pressure ranged 35-70 cm H 2O;functional urethral length ranged 2.6-3.5 cm and the residual urine volume ranged 0-38 ml.IVU showed that all the neobladders were ball-shaped with no ureteral stenosis,but reflux in 1 case and mild hydroureter and hydronephrosis in another 1.Renal function and electrolyte metabolism were normal in the 30 cases.No one suffered from urethral recurrence or neobladder tumor. Conclusions The results of orthotopic urinary diversion in women are satisfactory and this surgical technique can be preferred in selected women with bladder cancer after radical cystectomy.