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目的:探讨腹腔镜Studer原位回肠新膀胱术保留阴茎勃起及控尿功能的方法及疗效。方法:对严格选择的要求保留勃起功能的46例男性膀胱癌患者行腹腔镜全膀胱切除、Studer原位回肠新膀胱术。常规手术组(A组):22例行常规腹腔镜膀胱前列腺全切除,术中注意保护神经血管束。常规建立Studer原位回肠新膀胱后与后尿道连续缝合。改良手术组(B组):24例在腹腔镜膀胱全切时保留耻骨前列腺韧带及前列腺尖部0.5~1.0cm包膜,注意保护神经血管束等。重建Studer原位回肠新膀胱与尿道残端连续缝合,将前列腺尖部包膜及耻骨前列腺韧带缝合固定于新膀胱外壁。对两组术后的勃起功能及排尿、控尿功能等进行随访和比较。结果:手术均获成功。无一例中转开放手术。术后6个月随访,A组保留勃起功能者14例(63.6%),B组勃起功能保留者21例(87.5%),两组比较差异有统计学意义(P<0.05)。A组日间控尿率86.4%,夜间控尿率72.7%,尿失禁自我评价(ICIQ-SF)(9.2±3.8)分;B组日间控尿率91.7%,夜间控尿率83.3%,尿失禁自我评价(ICIQ-SF)(6.0±4.2)分。新膀胱尿流动力学检查A组最大尿流率(14±8)ml/s,剩余尿量(42.0±4.1)ml;B组最大尿流率(18±9)ml/s,剩余尿量(25.0±5.2)ml;两组比较,B组明显优于A组,但差异无统计学意义。结论:保留阴茎勃起及控尿功能的腹腔镜Studer原位回肠新膀胱术是一种较为理想的术式,疗效满意,值得临床推广。
Objective: To investigate the method and efficacy of laparoscopic orthotopic neobladder for preserving penile erection and urine control. Methods: Laparoscopic total cystectomy and Studer orthotopic ileal neo-bladder surgery were performed on 46 patients with strictly selected male bladder cancer requiring erectile function. Conventional surgery group (A group): 22 patients underwent routine laparoscopic total prostatectomy of the prostate, during operation to protect the neurovascular bundle. Conventional establishment of a new post-ileal intussusception bladder and posterior urethral continuous suture. In the modified surgery group (B group), 24 cases retained the pubococcal prostate ligament and the 0.5-1.0 cm capsule of the prostatic apex when the laparoscopic total cystectomy was performed. Attention should be paid to protect the neurovascular bundle and so on. Reconstruction Studer orthotopic ileum neo-bladder and urethral stump continuous suture, the prostate apex capsule and pubic prostate ligament sutured to the new bladder wall. The erectile function, urination and urine control of the two groups were followed up and compared. Results: The surgery was successful. No case of transfer surgery. Six months after the operation, 14 cases (63.6%) retained erectile function in group A, and 21 cases (87.5%) retained erectile function in group B, the difference was statistically significant (P <0.05). The daytime urine control rate was 86.4% in group A, 72.7% in nighttime, and 9.2 ± 3.8 in spontaneous incontinence (ICIQ-SF). The daytime urine control rate was 91.7% in group B and 83.3% Urinary incontinence self-assessment (ICIQ-SF) (6.0 ± 4.2) points. Neovascularization was performed in group A with the maximum uroflow rate of (14 ± 8) ml / s and the residual urine volume of (42.0 ± 4.1) ml; the maximum urinary flow rate of group B (18 ± 9) ml / s, 25.0 ± 5.2) ml; group B was better than group A, but the difference was not statistically significant. Conclusion: Laparoscopic nephrectomy with preserving penile erection and urine control is an ideal surgical procedure with satisfactory curative effect and worthy of clinical promotion.