CAJ | 학술논문

目的评价女性膀胱全切原位尿流改道的中远期疗效.方法回顾性分析2003年2月至2012年8月28例女性膀胱全切原位尿流改道患者的临床资料.所有患者均行膀胱全切加原位回肠新膀胱术,其中6例一并切除子宫.开放手术19例,腹腔镜手术9例.新膀胱重建采用T型回肠膀胱17例,改良Studer回肠膀胱11例.结果 28例均获随访,随访时间8～ 114个月,平均55个月.患者均能自行排尿,术后6、12和24个月,日间完全控尿率分别为82.1％、92.3％和90.5％;夜间完全控尿率分别为53.6％、88.5％和90.5％.术后6、12、24个月平均贮尿囊容量分别为(282±87) ml、(345±72) ml和(357 ±75)ml,充盈期平均贮尿囊压力分别为(10.8±3.2) cmH2O(1 cmH2O =0.098 kPa)、(6.7±2.6) cmH2O和(6.2 ±-2.1)cmH2O.膀胱阴道漏1例,手术修补治愈.尿道吻合口狭窄1例,经规律尿道扩张6个月治愈.血清电解质正常,肾功能稳定.无肿瘤复发及转移.结论女性膀胱癌患者原位尿流改道术远期疗效满意,是一种理想的尿流改道术式.
목적 평개녀성방광전절원위뇨류개도적중원기료효.방법 회고성분석2003년2월지2012년8월28례녀성방광전절원위뇨류개도환자적림상자료.소유환자균행방광전절가원위회장신방광술,기중6례일병절제자궁.개방수술19례,복강경수술9례.신방광중건채용T형회장방광17례,개량Studer회장방광11례.결과 28례균획수방,수방시간8～ 114개월,평균55개월.환자균능자행배뇨,술후6、12화24개월,일간완전공뇨솔분별위82.1％、92.3％화90.5％;야간완전공뇨솔분별위53.6％、88.5％화90.5％.술후6、12、24개월평균저뇨낭용량분별위(282±87) ml、(345±72) ml화(357 ±75)ml,충영기평균저뇨낭압력분별위(10.8±3.2) cmH2O(1 cmH2O =0.098 kPa)、(6.7±2.6) cmH2O화(6.2 ±-2.1)cmH2O.방광음도루1례,수술수보치유.뇨도문합구협착1례,경규률뇨도확장6개월치유.혈청전해질정상,신공능은정.무종류복발급전이.결론 녀성방광암환자원위뇨류개도술원기료효만의,시일충이상적뇨류개도술식.
Objective To assess the mid-long-term efficacies of orthotopic urinary diversion in women.Methods From February 2003 to August 2012,28 female patients with bladder cancer underwent radical cystectomy and orthotopic ileal neobladder.Open (n =18) and laparoscopic (n =9) procedures were performed.Ileal neobladder included 17 T-pouch and 11 modified Studer pouch reconstruction.The continence status,urodynamics,serum electrolyte and renal function were followed up.Results The mean follow-up period was 55 (8-114) months.Excellent continence was achieved during day-time in 82.1％,92.3％ and 90.5％ cases at 6,12 and 24 months postoperatively and in 53.6％,88.5％ and 90.5％ cases at night respectively.The mean capacity of pouch was 282 ± 87,345 ± 72 and 357 ± 75 ml at 6,12 and 24 months postoperatively respectively.The mean filling pressure of pouch was 10.8 ± 3.2,6.7 ± 2.6 and 6.2 ±2.1 cmH2O postoperatively respectively.One case of neobladder-vaginal fistula was cured by surgical repair.Another case of urethral stenosis responded well after regular dilation for 6 months.Renal function and electrolyte metabolism were stable in all cases.There was no instance of tumor recurrence or metastasis.Conclusion Orthotopic urinary diversion in females has excellent long-term results with fewer complications so that it is highly recommended.