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The clinical study of 120 cases total cystectomy and W shape orthotopic ileal neobladder
Author(s): 
Pages: 104-107
Year: Issue:  2
Journal: CHINESE JOURNAL OF SURGERY

Keyword:  膀胱肿瘤膀胱切除术泌尿外科手术治疗结果;
Abstract: 目的探讨膀胱全切原位W形回肠代膀胱术优缺点.方法 120例男性膀胱癌患者,其中浸润性膀胱移行细胞癌99例,移行细胞癌伴部分鳞化8例,移行细胞癌伴腺癌及鳞癌3例, 腺癌6例, 鳞癌4例,均行膀胱全切原位W形回肠代膀胱术.膀胱全切采用顺行、逆行相结合的方法.截取末段回肠,排列成W形,褥式缝合制作储尿袋.输尿管以乳头法包埋术种植.结果手术时间,前50例为210~300 mim,平均270 min;后70例为110~205 min,平均143 min.术后91例获得随访,随访2~88个月,平均30个月,85例白天可控制排尿,其中71例夜间可控制排尿.9例术后发生输尿管扩张,7例合并轻度肾积水,2例合并中度肾积水, 2例肾功能轻度异常.45例行膀胱造影仅1例发生右侧输尿管返流.术后3个月复查出现低血钾者6例,余85例血电解质均在正常范围.20例患者行尿动力检查,尿流曲线呈持续型12例,间歇型8例;膀胱尿道造影显示尿流持续型代膀胱颈口呈漏斗形,排尿时开放良好,而尿流间歇形代膀胱颈口不呈漏斗形或排尿时颈口开放欠佳.结论膀胱全切原位W 形回肠代膀胱术手术时间短,操作简单,出血少,并发症少,原位W形回肠代膀胱有较好的储尿和排尿功能,电解质紊乱发生率低.
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