中南大学学报（医学版）
中南大學學報（醫學版）
중남대학학보（의학판）
JOURNAL OF CENTRAL SOUTH UNIVERSITY (MEDICAL SCIENCES)
2014年
4期
379-383
,共5页
膀胱癌%膀胱全切%原位新膀胱%并发症
膀胱癌%膀胱全切%原位新膀胱%併髮癥
방광암%방광전절%원위신방광%병발증
bladder cancer%total cystectomy%orthotopic neobladder%complication
目的：探讨膀胱全切原位W形回肠新膀胱术治疗膀胱癌的临床疗效。方法：32例膀胱癌患者，其中男29例，女3例，均行膀胱全切原位W形回肠新膀胱术。膀胱全切后，截取35~40 cm末端回肠，排列成W形制作原位新膀胱。双侧输尿管与新膀胱乳头法吻合，尿道与新膀胱低位吻合。结果：所有患者手术均成功，术后患者可通过腹压自主排尿，白天控尿率为87.5%，夜间控尿率为78.1%。术后6个月平均膀胱容量410.6 mL，残余尿量22.7 mL。术后新膀胱漏尿3例，轻度肠梗阻2例，新膀胱尿道吻合口狭窄1例，新膀胱分泌物导致排尿困难3例，并发症经处理后效果满意。9例术前有勃起功能男性患者，术后5例保留勃起功能；1例保留子宫和附件女性患者术后性功能正常。平均随访15个月，1例患者因肺部感染、肿瘤远处转移死亡，其余患者均无瘤生存。结论：膀胱全切原位W形回肠新膀胱术治疗膀胱癌术后患者可原位排尿，控尿良好，上尿路损害与电解质紊乱发生率低，可作为膀胱全切尿流改道的首选。术后应注意并发症的处理和随访。
目的：探討膀胱全切原位W形迴腸新膀胱術治療膀胱癌的臨床療效。方法：32例膀胱癌患者，其中男29例，女3例，均行膀胱全切原位W形迴腸新膀胱術。膀胱全切後，截取35~40 cm末耑迴腸，排列成W形製作原位新膀胱。雙側輸尿管與新膀胱乳頭法吻閤，尿道與新膀胱低位吻閤。結果：所有患者手術均成功，術後患者可通過腹壓自主排尿，白天控尿率為87.5%，夜間控尿率為78.1%。術後6箇月平均膀胱容量410.6 mL，殘餘尿量22.7 mL。術後新膀胱漏尿3例，輕度腸梗阻2例，新膀胱尿道吻閤口狹窄1例，新膀胱分泌物導緻排尿睏難3例，併髮癥經處理後效果滿意。9例術前有勃起功能男性患者，術後5例保留勃起功能；1例保留子宮和附件女性患者術後性功能正常。平均隨訪15箇月，1例患者因肺部感染、腫瘤遠處轉移死亡，其餘患者均無瘤生存。結論：膀胱全切原位W形迴腸新膀胱術治療膀胱癌術後患者可原位排尿，控尿良好，上尿路損害與電解質紊亂髮生率低，可作為膀胱全切尿流改道的首選。術後應註意併髮癥的處理和隨訪。
목적：탐토방광전절원위W형회장신방광술치료방광암적림상료효。방법：32례방광암환자，기중남29례，녀3례，균행방광전절원위W형회장신방광술。방광전절후，절취35~40 cm말단회장，배렬성W형제작원위신방광。쌍측수뇨관여신방광유두법문합，뇨도여신방광저위문합。결과：소유환자수술균성공，술후환자가통과복압자주배뇨，백천공뇨솔위87.5%，야간공뇨솔위78.1%。술후6개월평균방광용량410.6 mL，잔여뇨량22.7 mL。술후신방광루뇨3례，경도장경조2례，신방광뇨도문합구협착1례，신방광분비물도치배뇨곤난3례，병발증경처리후효과만의。9례술전유발기공능남성환자，술후5례보류발기공능；1례보류자궁화부건녀성환자술후성공능정상。평균수방15개월，1례환자인폐부감염、종류원처전이사망，기여환자균무류생존。결론：방광전절원위W형회장신방광술치료방광암술후환자가원위배뇨，공뇨량호，상뇨로손해여전해질문란발생솔저，가작위방광전절뇨류개도적수선。술후응주의병발증적처리화수방。
Objective: To investigate the clinical effect of total cystectomy and W-shaped orthotopic ileal neobladder for bladder cancer. Methods: Total cystectomy and W-shaped orthotopic ileal neobladder were performed on 29 male patients and 3 female patients. Atfer the cystectomy, 35-40 cm terminal ileal segment was isolated to make W-shaped orthotopic ileal neobladder. Bilateral uretero-ileal anastomoses were constructed by nipple technique, urethral stump was sutured to the lowest portion of the ileal pouch. Results: All surgeries were completed successfully. Patients were able to void by increasing the abdominal pressure, daytime continence rate was 87.5% and nighttime continence rate was 78.1%. The mean neobladder capacity was 410.6 mL and the mean postvoid residual urine was22.7 mL at 6 months. After the surgery, ileal neobladder leakage occurred in 3 (9.4%) patients, mild ileus occurred in 2 (6.3%) patients, ileo-urethral anastomosis stricture developed in 1(3.1%) patient, and dysuria occurred in 3 (9.4%) patients because of the mucus.HTe complications were treated properly and satisfactory results were obtained. Erection was preserved in 5 of the 9 male patients with normal erectile function, and normal sexual function was preserved in 1 female patient who underwent uterus-sparing cystectomy. HTe mean follow-up was 15 months.One patient died of distant metastasis and pneumonia, while other patients survived without tumor. Conclusion: Total cystectomy and W-shaped orthotopic ileal neobladder have the advantages of voiding through the native urethra, satisfactory continence, low complication rates of upper urinary tract damage and electrolyte imbalance. W-shaped orthotopic ileal neobladder may be considered as the ifrst option of urinary diversion atfer cystectomy. Postoperative management should focus on complications and follow-up.
