摘要
目的比较胃、回肠原位代膀胱术后临床效果及并发症。方法回顾分析我科从2001年3月至2008年5月84例膀胱癌全膀胱切除+原位胃、回肠代膀胱术患者的临床资料、实验室检查、影像学检查、尿动力学检查、膀胱镜检查结果。其中,胃代膀胱44例,回肠代膀胱40例。结果随访4～78个月,所有患者经尿道排尿,未发生水、电解质、酸碱平衡紊乱,肾功能正常,无肾积水、输尿管扩张。胃代膀胱:容量290～530ml,平均395ml,排尿间隔时间2～4.8h,平均3.2h,最大尿流率12.8～26.2ml/s,平均18.4ml/s,充盈期膀胱压5～15cmH2O,平均10cmH2O;44例白天均能自控排尿,夜间遗尿8例,8例均出现不同程度尿道灼痛;残余尿10～110ml,平均36ml;尿pH4.5～6.7,平均5.8;尿路感染13例;膀胱镜检查见胃黏膜光滑平整、色泽稍苍白,未见溃疡。回肠代膀胱:容量350～550ml,平均426ml,排尿间隔时间2～4.6h,平均3.4h,最大尿流率13.5～26ml/s,平均18.8ml/s,充盈期膀胱压6～15cmH2O,平均10cmH2O,40例白天均能自控排尿,夜间遗尿5例,残余尿10～150ml,平均38ml,尿pH6.0～7.2;尿路感染35例次,其中4例拔除尿管后出现上尿路感染、高热。膀胱镜检见较多肠黏液,肠黏膜光滑平整、色泽稍苍白,未见溃疡。结论胃、回肠原位膀胱均能获得较满意的贮尿功能,多数患者术后能满意控尿。术后各相关生理指标基本正常。回肠代膀胱术后发生尿路感染明显多于胃代膀胱,胃代膀胱术后尿pH降低可致尿道灼痛。
Objective To compare the clinical outcome and complications of stomachal orthotopic neobladder and ileal orthotopic neobladder.Methods We retrospectively reviewed the medical records,laboratory evaluations,imaging examination,cystoscopy,urodynamic studies of 84 bladder cancer patients who had undergone total cystectomy in our department during March 2001 to May 2008.Among them,there were 44 cases of substitution of wedge-shaped stomach for urinary bladder,and 40 cases of substitution of ileum for urinary bladder.All the 84 patients were followed up for 4 to 78 months.Results These patients micturated through the urethra.There was no disturbance of water and electrolyte metabolism,no hydronephrosis and ureterectasis,no uracratia,and no damage to renal function.In the patients with stomachal neobladder,the bladder capacity was 290 to 530 ml （mean 395 ml）,the urination interval was 2 to 4.8 h （mean 3.2 h）,the maximal flow rate was 12.8 to 26.2 ml/s （mean 18.4 ml/s）,and the filling bladder pressure was 5 to 15 cmH2O （mean 10 cmH2O）.The residual urine was 10 to 110 ml （mean 36 ml）,and the pH value of urine was 4.5 to 6.7 （mean 5.8）.All of the 44 cases achieved continence during daytime,and 8 cases who developed enuresis had urethralgia.Urinary tract infections occurred in 13 cases.Postoperative cystoscopy showed that gastrocystic mucosa was even and smooth in white color without ulcer.While,in the patients with ileal neobladder,the bladder capacity was 350 to 550 ml （mean 426 ml）,the urination interval was 2 to 4.6 h （mean 3.4 h）,the maximal flow rate was 13.5 to 26 ml/s （mean 18.8 ml/s）,and the filling bladder pressure was 6 to 15 cmH2O （mean 10 cmH2O）.The residual urine was 10 to 150 ml （mean 40 ml）,and the pH value of urine was 6.0 to 7.2 （mean 6.5）.All of the 40 cases achieved continence during daytime,and 5 cases were incontinent at night.Urinary tract infections occurred in 35 cases,and among them,upper urinary tract infections occurred in 4 cases who had a high fever.Postoperative cystoscopy showed that ileal neobladder mucosa was even and smooth in white color without ulcer,and there was much mucus in the neobladder.Conclusion Filling function and continence status of stomachal or ileal orthotopic neobladder are satisfactory after radical cystectomy.Our results show that there is significant increase in risk of urinary tract infection occurring in the patients with ileal neobladder.In the patients with stomachal neobladder,one of common complications is urethralgia,but it doesn’t occur in the patients with ileal neobladder.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2010年第10期1102-1105,共4页
Journal of Third Military Medical University
关键词
膀胱癌
胃原位膀胱
回肠原位膀胱
尿动力学
bladder cancer
stomachal orthotopic neobladder
ileal orthotopic neobladde
urodynamics
