改良膀胱全切新回肠膀胱术治疗男性浸润性膀胱癌

目的 探讨根治性全膀胱切除术中保留远端的前列腺包膜及精囊对原位新膀胱功能及勃起功能的影响。方法 对24例男性浸润性膀胱癌患者施行改良根治性全膀胱切除及原位回肠膀胱术：保留远端的前列腺外科包膜及精囊，新回肠膀胱与残留前列腺包膜连续缝合；对术后新膀胱的储尿、排尿、控尿功能及患者的勃起功能进行随访和比较。结果 术后病理分期：T2aN0M0 5例，T2bN0M0 9例，T3aN0M0 7例，T3bN1M0 3例。术后随访3—24个月，平均12．7月。无瘤生存22例；带瘤生存2例。新膀胱容量（385±68）mL，最大充盈压（24±16）cmH2O。排尿良好，最大尿流率（18±5）mL／s，剩余尿（35±16）mL；完全控尿22例，夜间尿失禁2例；21例术前勃起功能正常者术后2例发生勃起功能障碍。结论 在改良根治性膀胱全切术中保留远端的前列腺外科包膜及精囊，可明显改善患者术后的储尿、排尿、控尿功能和勃起功能，同时可有效防止新膀胱一尿道吻合口狭窄的发生。

The modified radical cystectomy and orthotopic neobladder for male patients with invasive bladder cancer

Objective To investigate the effects of partial prostatic capsula seminal vesicles and surrounding striated sphincter sparing surgery on the function of orthotopic ileal neobladder and erectile function. Methods Total cystectomy with partial prostatectomy and orthotopic ileal neobladder was performed on 24 male patients with invasive bladder cancer. With apex-sparing radical cystectomy, the prostatic capsula seminal vesicles below the verumontanum with its surrounding striated urethral sphincter was retained. The neobladder was anastomosed with the residual capsula using continuous suture. The function of the neobladder and erectial function was evaluated. Results The pathological classification of the 24 patients was as follows; 5 cases of T2aN0M0; 9 cases of T2bN0M0; 7 cases of T3aN0M0; and 3 cases of T3bN1M0. The patients were followed up for 3 to 24 months （mean 12.7 months）. 22 patients survived tumor free and 2 survived with metastasis. The capacity of the neobladder was （385±68）mL, and the intrareservoir pressure was （24±16）cmH20. All the 24 patients voided well with Qmax （18± 5）mL/s, and residual volume of （35± 16）mL. Complete urinary continence was achieved in 22 patients and the other 2 had nocturnal incontinence. The preoperative grade of potency was preserved in 19 of 21 patients. Conclusion Partial prostatic capsula seminal vesicles and its surrounding striated sphincter sparing surgery can improve the continence and voiding of the orthotopic neobladder and improve erectile function. We are able to create a wide neovesicourethral anastomosis to prevent strictures.