膀胱全切原位尿流改道术治疗膀胱非尿路上皮癌的疗效评价

目的：评价膀胱全切原位尿流改道术治疗膀胱非尿路上皮癌的疗效.方法：对17例膀胱非尿路上皮癌患者行根治性膀胱全切,盆腔淋巴结清扫;然后取一段肠管缝制成新膀胱,分别与输尿管和尿道残端吻合,实现原位尿流改道.结果：手术均获成功,手术时间172～380 min,平均310 min.16例获得随访,平均随访67个月（1～16年）.6例因肿瘤复发或转移于5年内死亡,2例死于非肿瘤因素,1例仍在随访,7例存活已达5年.结论：根治性膀胱全切原位尿流改道术治疗膀胱非尿路上皮癌,具有较好的治疗效果,能明显改善患者生活质量.

Therapeutic Evaluation of Orthotopic Urinary Diversion for Non-Transitional Cell Cancers of Bladder

Objective：To evaluate the surgical effects of radical cystectomy with orthotopic urinary diversion for non--transitional cell cancers of bladder. Methods：A total of 17 patients who were were non--urothelial blad der cancer do radical cystectomy and pelvic lymph node dissection, a segment of intestine or sigmoid was divided to make a neobladder, then the neobladder was anastomosed to the urethra and bilateral ureters with interrupted stitches to achieve in situ urinary diversion. Results： All the operations were successful, the mean operative time was 310 rain （172--380 min）. 16 cases were followed up for 67 months （1-16 years）, 6 patients died of recurrence or metastasis within 5 years from operation, 2 cases died of non--tumor diseases, 1 case still under follow--up, 7 cases survived more than 5 years. Conclusions： Radical cystectomy with orthotopic urinary diversion for non--transitional cell cancers of bladder did not compromise the cancer control according to the preliminary clinical outcome, but improved the quality of life.