中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2009年
10期
677-680
,共4页
邱学德%徐鸿毅%石永福%李泽惠%李炯明%王剑松%李志鹏%方克伟%曾贵华%李海丹%何进%和术臣
邱學德%徐鴻毅%石永福%李澤惠%李炯明%王劍鬆%李誌鵬%方剋偉%曾貴華%李海丹%何進%和術臣
구학덕%서홍의%석영복%리택혜%리형명%왕검송%리지붕%방극위%증귀화%리해단%하진%화술신
膀胱肿瘤%回肠%原位新膀胱%随访研究
膀胱腫瘤%迴腸%原位新膀胱%隨訪研究
방광종류%회장%원위신방광%수방연구
Bladder neoplasmas%lleal%Orthotopic neobladder%Follow-up studies
目的 总结回肠原位新膀胱手术的远期效果. 方法 1991至1998年共施行回肠原位新膀胱手术79例.男73例,女6例.平均年龄55(41～75)岁.术后随访时行肾功能、电解质、血常规等测定,B超测定残余尿,作IVU或MRU检查;测量术后5、10～14和15年患者肾盂最大横径和膀胱最大垂直和水平径线,不同时段结果间作两两比较;观察肿瘤局部或远处是否复发以及手术并发症等. 结果获随访64例.男58例,女6例.平均随访167(121～216)个月.死于非肿瘤原因7例,肿瘤盆腔复发7例,尿道复发2例,死于肿瘤远处转移3例,输尿管再发肿瘤1例,新膀胱再发肿瘤1例.存活时间＞10年者48例,术后5、10～14和15年患者SCr、BUN、K+、Na+、Cl-、Ca2+和血红蛋白测定均在正常值范围,且不同时段间比较差异无统计学意义(P＞0.05);5、10～14和15年平均肾盂最大横径分别为14.0、14.1和13.7 mm(P＞0.05);平均膀胱最大垂直径线分别为110.4,111.5和127.0 mm,水平径线分别为90.4、95.3、97.0 mm(P＞0.05).残余尿＞50 ml者5例,随访期间残余尿量均未见明显增加.发生新膀胱结石8例,经腔内碎石治愈;尿道狭窄2例,经内切开治愈;腹股沟疝14例,再手术治愈12例.无与手术或肿瘤有关并发症者17例. 结论回肠原位新膀胱术后上尿路和新膀胱功能能够保持长期稳定,肿瘤治愈率满意,但术后需要终身随访.
目的 總結迴腸原位新膀胱手術的遠期效果. 方法 1991至1998年共施行迴腸原位新膀胱手術79例.男73例,女6例.平均年齡55(41～75)歲.術後隨訪時行腎功能、電解質、血常規等測定,B超測定殘餘尿,作IVU或MRU檢查;測量術後5、10～14和15年患者腎盂最大橫徑和膀胱最大垂直和水平徑線,不同時段結果間作兩兩比較;觀察腫瘤跼部或遠處是否複髮以及手術併髮癥等. 結果穫隨訪64例.男58例,女6例.平均隨訪167(121～216)箇月.死于非腫瘤原因7例,腫瘤盆腔複髮7例,尿道複髮2例,死于腫瘤遠處轉移3例,輸尿管再髮腫瘤1例,新膀胱再髮腫瘤1例.存活時間＞10年者48例,術後5、10～14和15年患者SCr、BUN、K+、Na+、Cl-、Ca2+和血紅蛋白測定均在正常值範圍,且不同時段間比較差異無統計學意義(P＞0.05);5、10～14和15年平均腎盂最大橫徑分彆為14.0、14.1和13.7 mm(P＞0.05);平均膀胱最大垂直徑線分彆為110.4,111.5和127.0 mm,水平徑線分彆為90.4、95.3、97.0 mm(P＞0.05).殘餘尿＞50 ml者5例,隨訪期間殘餘尿量均未見明顯增加.髮生新膀胱結石8例,經腔內碎石治愈;尿道狹窄2例,經內切開治愈;腹股溝疝14例,再手術治愈12例.無與手術或腫瘤有關併髮癥者17例. 結論迴腸原位新膀胱術後上尿路和新膀胱功能能夠保持長期穩定,腫瘤治愈率滿意,但術後需要終身隨訪.
목적 총결회장원위신방광수술적원기효과. 방법 1991지1998년공시행회장원위신방광수술79례.남73례,녀6례.평균년령55(41～75)세.술후수방시행신공능、전해질、혈상규등측정,B초측정잔여뇨,작IVU혹MRU검사;측량술후5、10～14화15년환자신우최대횡경화방광최대수직화수평경선,불동시단결과간작량량비교;관찰종류국부혹원처시부복발이급수술병발증등. 결과획수방64례.남58례,녀6례.평균수방167(121～216)개월.사우비종류원인7례,종류분강복발7례,뇨도복발2례,사우종류원처전이3례,수뇨관재발종류1례,신방광재발종류1례.존활시간＞10년자48례,술후5、10～14화15년환자SCr、BUN、K+、Na+、Cl-、Ca2+화혈홍단백측정균재정상치범위,차불동시단간비교차이무통계학의의(P＞0.05);5、10～14화15년평균신우최대횡경분별위14.0、14.1화13.7 mm(P＞0.05);평균방광최대수직경선분별위110.4,111.5화127.0 mm,수평경선분별위90.4、95.3、97.0 mm(P＞0.05).잔여뇨＞50 ml자5례,수방기간잔여뇨량균미견명현증가.발생신방광결석8례,경강내쇄석치유;뇨도협착2례,경내절개치유;복고구산14례,재수술치유12례.무여수술혹종류유관병발증자17례. 결론회장원위신방광술후상뇨로화신방광공능능구보지장기은정,종류치유솔만의,단술후수요종신수방.
Objective To discuss the long term clinical effect of ileal orthotropic neobladder.Methods From 1991 to 1998,79 patients,mean age 55(41～75)years,male 74,female 6,were followed up.The serum creatinine and urea,electrolytes,blood routine,B ultrasonic scan of the neobladder residual urine and IVU or MRU of the patients were followed up.The max transverse diameter of renal pelvis and the max verticaI/level diameter of neobladder were measured in 5,10 to 14,15 years of postoperative when IVU or MRU.All results of different time were compared by the multiple comparisons.The local or distant cancer recurrence and the complications of the operation Were evaluated. Results Sixty-four cases,58 male,6 famle,were long term followed up:mean time was 167 (range,121～216)months.Seven cases died of other diseases.Seven cases had pelvic recarrence.Two cases had urethral recurrence.Three cases died of tumor metastasis.One case had ureter recurrence.Forty-eight patients were alive more than 10 years.The value of the serum creatinine,urea,electrolytes and bloods routine of the patients were normal after 5,10 to 14 and 15 vears postoperative (P＞0.05).The max transverse diameter of the renal pelvis in 5,10 to 14 and 15 years Dostoperative were 14.0 mm,14.1 mm and 13.7 mm,respectively,P＞0.05.The max vertical/level diameter of the neobladder in 5,10 to 14,15 years of postoperative were 110.4 mm/90.4 mm,111.5 mm/95.3mm and 127.0 mm/97.0 mm,respectively,P＞0.05.The residual urine of 5 cases was more than 50 ml and had not increased during follow up.Eight cases with neobladder stone were cured by the intracavitary lithothrypsis.Two cases with uretheral stricture were cured by the intracavitary therapy.Twelve cases of 14 cases with inguinal hernia were cured by reoperation,2 cases accepted conservative treatment.Only 17 cases had no complication involve of the cancer and the operation. Conclusion The upper urinary tract and neobladder of the ileal orthotopic neobladder could be stable for long time,the cure rate of tumor is satisfactory and the lifetime follow up is necessary.
