论文部分内容阅读
目的探索全膀胱切除术后原位回肠新膀胱术的临床疗效。方法对所有患者均行全膀胱切除术及W形原位新膀胱术,膀胱全切除采用顺行逆行相结合的方法;采用带蒂末段回肠片经W形折叠后缝合形成的原位类球形新膀胱,输尿管以乳头法包埋术种植于新膀胱,新膀胱底部与尿道残端吻合。就术后并发症、新膀胱储尿量、术后控尿排尿情况、影像学及生化检查等进行随访,随访时间6~60个月,平均28个月。结果平均手术时间为5小时,术中平均出血量400ml,15例白天均能控尿,夜尿1~3次;夜间遗尿1例;尿漏1例,膀胱容量大,压力低。血电解质基本正常。B超检查无上尿路扩张积水。膀胱镜检查无尿道肿瘤复发。结论全膀胱切除-原位回肠新膀胱术是治疗浸润性膀胱癌的一个优良方案。
Objective To explore the clinical efficacy of orthotopic ileal neobladder after total cystectomy. Methods All patients underwent total cystectomy and W-shaped orthotopic neobladder surgery. The total cystectomy was performed by antegrade retrograde approach. The pedicled ileal segment was formed by W-folded posterior suture. The neo-bladder and ureter were implanted in the neo-bladder by nipple embolization. The bottom of the new bladder was anastomosed to the stump of the urethra. Postoperative complications, new bladder urine volume, postoperative urinary urinary tracturia, imaging and biochemical tests were followed up for 6 to 60 months with an average of 28 months. Results The average operation time was 5 hours. The average blood loss during the operation was 400ml. 15 cases were able to control the urine during the day, nocturia was 1 to 3 times, nocturnal enuresis occurred in 1 case, and urinary leakage occurred in 1 case. The bladder had large capacity and low pressure. Blood electrolytes are normal. B-ultrasonography does not have an upper urinary tract dilatation. Cystoscopy showed no recurrence of urinary tract tumors. Conclusion Total cystectomy-orthotopic ileal neobladder is an excellent treatment for invasive bladder cancer.