CAJ | 학술논문

目的探讨女性可控性回肠膀胱术的远期随访疗效.方法女性膀胱肿瘤患者19例,年龄45～66岁,平均52岁.病程16 d～1.9年,平均4.4个月.临床表现均有间歇性无痛性全程血尿.肿瘤单发14例,多发5例.活检病理均为移行细胞癌.分级:G1 10例、G2 7例、G3 2例,UICC分期:pT1 5例、pT2 12例、pT3a 2例.肿瘤距膀胱颈部>2cm.尿道无肿瘤,无尿失禁.19例均采用改良根治性膀胱全切除术,不切除子宫及阴道前壁,保护支配尿道的神经,清除盆腔脂肪淋巴组织,切除近端尿道0.8～1.2cm.应用末端回肠30 cm制作新膀胱.原位尿道吻合.结果 19例手术及术后恢复顺利.术后失访3例.16例随访6～102个月,平均71个月.无瘤存活15例,术后17个月死于心肌梗死1例.术后9个月昼、夜控尿率分别为100%(16/16)和93%(14/15).术后9个月,15例行尿动力学测定,新膀胱容量(519.0±53.0)ml,残余尿量(29.2±4.9)ml,最大尿流率(18.6±2.8)ml/s;平均充盈压力和排尿压力分别为(16.7±3.5)和(53.0±5.0)cm H2O(1 cm H2O=0.098 kPa).术后9个月IVU检查单侧上尿路轻度积水1例,血BUN、Cr、电解质及二氧化碳结合力均正常.肿瘤无复发.结论女性可控性回肠膀胱术后控尿功能良好,新膀胱容量大、压力低、顺应性好,并发症少,是女性膀胱原位重建的良好术式.
목적 탐토녀성가공성회장방광술적원기수방료효.방법 녀성방광종류환자19례,년령45～66세,평균52세.병정16 d～1.9년,평균4.4개월.림상표현균유간헐성무통성전정혈뇨.종류단발14례,다발5례.활검병리균위이행세포암.분급:G1 10례、G2 7례、G3 2례,UICC분기:pT1 5례、pT2 12례、pT3a 2례.종류거방광경부>2cm.뇨도무종류,무뇨실금.19례균채용개량근치성방광전절제술,불절제자궁급음도전벽,보호지배뇨도적신경,청제분강지방림파조직,절제근단뇨도0.8～1.2cm.응용말단회장30 cm제작신방광.원위뇨도문합.결과 19례수술급술후회복순리.술후실방3례.16례수방6～102개월,평균71개월.무류존활15례,술후17개월사우심기경사1례.술후9개월주、야공뇨솔분별위100%(16/16)화93%(14/15).술후9개월,15례행뇨동역학측정,신방광용량(519.0±53.0)ml,잔여뇨량(29.2±4.9)ml,최대뇨류솔(18.6±2.8)ml/s;평균충영압력화배뇨압력분별위(16.7±3.5)화(53.0±5.0)cm H2O(1 cm H2O=0.098 kPa).술후9개월IVU검사단측상뇨로경도적수1례,혈BUN、Cr、전해질급이양화탄결합력균정상.종류무복발.결론 녀성가공성회장방광술후공뇨공능량호,신방광용량대、압력저、순응성호,병발증소,시녀성방광원위중건적량호술식.
Objective To evaluate the clinical application of female orthotopic ileal neobladder.Methods Modified radical cysteetomy plus orthotopic ileal neobladder was performed on 19 female pa-tients with bladder cancer from June 1999 to January 2008.The mean age of the patients was 52(45-66) years,mean course of disease was 4.4 months (16 days-1.9 years).Of all the patients,there were 10 cases with grade 1,7 cases with grade 2 and 2 cases grade 3.According to the UICC stage system,5 patients were T1 stage,12 T2 and 2 T3a.All the patients received modified radical cystecto-my without resection of uterus and anterior vagina,meanwhile the nerves around urethra were protec-ted.0.8-1.2 cm proximal end of the urethra was excised and 30 cm distal ileum was used for the re-construction of the neobladder.Results Sixteen cases were followed up for 6-102 months,mean 71 months.Fifteen patients survived without disease recurrence,1 patient died of myocardial infarc-tion 17 months postoperation.The daytime and night continent rate was 100$,93% at 9 months postoperative.The average voiding volume of the 15 patients was 519.0 ml.The average residual vol-ume was 29.2 ml,and Qmax was 18.6 ml/s.The average filling and voiding pressure was 16.7 cm H2O and 53.0 cm H2O.Intravenous urography showed slight hydronephrosis in 1 case.Conclusion Female orthotopic ileal neobladder could be a good choice because of the continence,fewer complica-tions,lower pressure and enough bladder capacity.