CAJ | 학술논문

目的本研究旨在探讨改良根治性全膀胱切除术中保留前列腺远端包膜对改善原位新膀胱功能的作用。方法对27例男性膀胱癌患者行全膀胱切除并肠道原位新膀胱术。分两组：1手术改良组：15例,在膀胱切除时保留远端部分前列腺外科包膜及其周围横纹括约肌,新膀胱与残留前列腺包膜连续缝合；2经典手术组：12例,常规行全膀胱和前列腺切除,新膀胱与后尿道间断缝合。对两组新膀胱术后的控尿和排尿功能进行随访和比较。结果术后随访3~36个月,手术改良组：15例新膀胱排尿良好,剩余尿0~50 ml；完全控尿14例,夜间尿失禁1例。经典手术组：9例排尿好,剩余尿20~100 ml,3例剩余尿100~200 ml,需要不定期间歇导尿；完全控尿9例,昼夜尿失禁1例,夜间尿失禁2例。结论在改良根治性膀胱全切术中保留远端的前列腺包膜,可明显改善患者术后的排尿、控尿功能
목적본연구지재탐토개량근치성전방광절제술중보류전렬선원단포막대개선원위신방광공능적작용。방법대27례남성방광암환자행전방광절제병장도원위신방광술。분량조：1수술개량조：15례,재방광절제시보류원단부분전렬선외과포막급기주위횡문괄약기,신방광여잔류전렬선포막련속봉합；2경전수술조：12례,상규행전방광화전렬선절제,신방광여후뇨도간단봉합。대량조신방광술후적공뇨화배뇨공능진행수방화비교。결과술후수방3~36개월,수술개량조：15례신방광배뇨량호,잉여뇨0~50 ml；완전공뇨14례,야간뇨실금1례。경전수술조：9례배뇨호,잉여뇨20~100 ml,3례잉여뇨100~200 ml,수요불정기간헐도뇨；완전공뇨9례,주야뇨실금1례,야간뇨실금2례。결론재개량근치성방광전절술중보류원단적전렬선포막,가명현개선환자술후적배뇨、공뇨공능
Objective This study was to assess the impact of preservation of distal prostatic capsula during modified radical cystectomy on the functions of orthotopic ideal neobladder function of bladder cancer patients . Methods Total cystectomy and orthotopic intestinal neobladder was performed in 27 male patients with invasive bladder cancer . The patients were divided into classical cystectomy group ( n=12) and modified cystectomy group ( n=15). In the classical group the prostate was removed completely and the residual urethrawas anastomosed with the neobladder using interrupted suture. In the modified group transurethral resection of the prostate preceded the cystectomy, and the prostatic capsula below the verumontanum with its surrounding striated urethral sphincter was retained. The neobladder was anastomosed with the residual capsula using continuous suture. The function of the neobladder in the 2 groups was evaluated and compared. Results The patients were followed up for 3 to 36 months . In modified group, All the 15 patients voided well with residual volume of 0 to 50 ml. Complete urinary continence was achieved in 14 patients and the remaining 1 had nocturnal incontinence. In classical group, of them 9 voided well with residual volume of 20 to 100 ml and the other 3 needed intermittent catheterization because of their residual urine being up to 100 to 200 ml. Complete continence was achieved in 9 patients and the other 3 were incontinent(1 with incontinence day and night,2 with nocturnal incontinence). Conclusions Preserving distal prostatic capsula vesicle can improve the continence and voiding functions of the orthotopic neobladder.