CAJ | 학술논문

目的探讨回肠原位新膀胱术中输尿管与储尿囊抗反流技术的临床应用价值.方法 2009年1月至2014年1月对27例根治性膀胱切除术患者行抗反流原位回肠新膀胱术.男23例,女4例.年龄41～77岁,平均61岁.27例均经膀胱镜活检确诊为膀胱尿路上皮细胞癌.临床分期:T1～ T2N0M019例,T3N0M08例.均在全麻下行根治性膀胱切除术+带回肠输入段的抗反流新膀胱术.术中按标准方法行根治性膀胱切除术后,取回肠约48 cm构建新膀胱,其中10～12 cm为输入段,储尿囊与回肠输入段交界处2～3 cm缝合形成抗反流的回肠壁瓣膜.将双侧输尿管直接拖入回肠输入段内约1 cm,输尿管与回肠浆肌层双排缝合固定吻合.结果本组27例手术均顺利完成.手术时间300 ～ 450 min,平均320 min.术中出血量250～1 200 ml,平均400 ml.抗反流回肠壁瓣膜成形+储尿囊构建时间35 ～ 50 min,平均41 min.术中无并发症发生.术后随访3～44个月,平均21个月,无膀胱输尿管反流和吻合口狭窄病例.术后3、6、12、24个月患者日间完全控尿率分别为66.7％ (18/27)、75.0％ (18/24)、95.7％(22/23)、100.0％ (16/16);夜间完全控尿率分别为59.3％(16/27)、70.8％ (17/24)、86.9％(20/23)、93.8％(15/16).22例术后6、12个月行尿动力学检查,最大新膀胱容量分别为360、430 ml;最高充盈膀胱压分别为17、14 cmH2O(1 cmH2O=0.098 kPa).结论抗反流回肠壁瓣膜成形联合输尿管拖入吻合技术构建的原位新膀胱具有较好的功能效果,术中操作简易、快速、可靠,术后无输尿管反流和膀胱吻合口狭窄.
목적 탐토회장원위신방광술중수뇨관여저뇨낭항반류기술적림상응용개치.방법 2009년1월지2014년1월대27례근치성방광절제술환자행항반류원위회장신방광술.남23례,녀4례.년령41～77세,평균61세.27례균경방광경활검학진위방광뇨로상피세포암.림상분기:T1～ T2N0M019례,T3N0M08례.균재전마하행근치성방광절제술+대회장수입단적항반류신방광술.술중안표준방법행근치성방광절제술후,취회장약48 cm구건신방광,기중10～12 cm위수입단,저뇨낭여회장수입단교계처2～3 cm봉합형성항반류적회장벽판막.장쌍측수뇨관직접타입회장수입단내약1 cm,수뇨관여회장장기층쌍배봉합고정문합.결과 본조27례수술균순리완성.수술시간300 ～ 450 min,평균320 min.술중출혈량250～1 200 ml,평균400 ml.항반류회장벽판막성형+저뇨낭구건시간35 ～ 50 min,평균41 min.술중무병발증발생.술후수방3～44개월,평균21개월,무방광수뇨관반류화문합구협착병례.술후3、6、12、24개월환자일간완전공뇨솔분별위66.7％ (18/27)、75.0％ (18/24)、95.7％(22/23)、100.0％ (16/16);야간완전공뇨솔분별위59.3％(16/27)、70.8％ (17/24)、86.9％(20/23)、93.8％(15/16).22례술후6、12개월행뇨동역학검사,최대신방광용량분별위360、430 ml;최고충영방광압분별위17、14 cmH2O(1 cmH2O=0.098 kPa).결론 항반류회장벽판막성형연합수뇨관타입문합기술구건적원위신방광구유교호적공능효과,술중조작간역、쾌속、가고,술후무수뇨관반류화방광문합구협착.
Objective To evaluate the clinical value of the orthotopic ileal neobadder with the ileum valvuloplasty and pulling antireflux technique for ureteroileal anastomosis.Methods The data of 27 cases underwent orthotopic ileal neobadder of which all cases with multiple or invasive carcinoma of bladder.There were 23 males and 4 females with an average of 61 (41-77) yrs accepted antireflux ileal neobladder with an afferent tubular segment after the radical cystectomy from Jan.2009 to Jan.2014.The clinic stage in these patients included in 19 T1-2N0M0 cases and 8 T3N0M0 cases.In our technique,we retrieved the intestinal about 48 cm for the construction of neobadder,with 10-12 cm used as input segment,and pouch input section of ileum junction 2-3 cm sutured to form ileum valve anti reflux;pulling the ureter inside of the afferent tubular ileal segment,with two rows sutures fixing the seromuscular layer of the ureter to the seromuscular layer of the ileal segment.The following parameters were considered:operative time,complications and functional outcomes.Results The mean operative time,and intraoperative blood loss were 320 (300-450) min and 400 (250-1 200) ml,respectively.The operative time for neobladder reconstruction was 41 (35 to 50) min.Follow-up was 21 (3 to 44) mon.No sever complications or stricture of the ureteral-neobladder anastomisis were recorded.The day time continence rates at 3,6,12 and 24 months postoperatively daytime were 66.7％,75.0％,95.7％ and 100.0％,nighttime 59.3％,70.8％,86.9％ and 93.8％,respectively.Urodynamic studies were performed in 22 patients,6 months and one year after surgery,the average maximal neigladder capacity was 360 ml and 430 ml,the average pressure at maximal capacity was 17 cmH2O and 14 cmH2O.Conclusions The antireflux ileal neobladder with an afferent tubular segment have good functional outcomes.Technique for ureteroileal anastomosis in orthotopic ileal neobladder avoids stenosis.It is easy,rapid and reliable procedure.