腹腔镜膀胱根治性切除原位回肠新膀胱的随访疗效观察

目的随访探讨腹腔镜膀胱根治性切除原位回肠新膀胱术的疗效。方法 61例行腹腔镜膀胱根治性切除原位回肠新膀胱术的膀胱癌患者,随访1~24个月,每月定期门诊复查、电话等方式详细记录术后自主排尿情况等资料。结果所有患者均未见肿瘤复发。42例患者于拔除尿管后28~35d自控通畅排尿,每次尿量约180~410mL,每次间隔60~180min;13例患者出院后仍有不同程度日间尿失禁现象,6例有夜间尿失禁现象;3例术前性功能正常男性患者出现勃起功能障碍;彩超及静脉肾盂造影检查发现4例单侧肾积水,2例双肾积水。结论腹腔镜膀胱根治性切除原位回肠新膀胱术肿瘤控制好,患者术后可具有较好的控尿功能和较低的尿失禁发生率,部分有效保存性功能,能够有效确保患者的生活质量。

The curative effect of laparoscopic radical cystectomy for orthotopic ileal neobladder

Objective To explore the curative effect of laparoscopic radical cystectomy for orthotopic ileal neobladder. Methods A total of 61 patients with orthotopic ileal neobladder treated with laparoscopic radical cystectomy were followed up for 1 to 24 months. The patients were interviewed through telephone and data were collected. Results No tumor re- curred. 42 patients had no incontinence 28--35 days after extubation. The urine volume was 180-410 mL, with an interval of 60-180 minutes. 13 patients had different degree of daytime incontinence, among them 6 also had night incontinence. 3 pa- tients suffered from erectile dysfunction, and 6 patients had hydronephrosis indicated by ultrasound and IVP. Conclusions Laparoscopic radical cystectomy is effective to treat orthotopic ileal neobladder and reserve patients＇ quality of life. Patients have good post-operative urinary control and low rate of incontinence. Some patients can maintain sexual function.