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Continent urinary diversion and ileal orthotopic neobladder (report of 68 cases)
Author(s): 
Pages: 461-463
Year: Issue:  8
Journal: CHINESE JOURNAL OF UROLOGY

Keyword:  膀胱肿瘤可控性尿流改道回肠新膀胱;
Abstract: 目的评价不同术式可控性膀胱术及回肠新膀胱术的疗效. 方法对68例膀胱全切除术后患者采用4种可控性尿流改道及回肠新膀胱术式,术后对患者控尿、导(排)尿,贮尿囊容积、内压,影像学及血生化资料进行比较. 结果回肠套叠式输出道3例中有2例部分脱套致术后尿失禁,需再次手术;缩窄末端回肠式输出道44例控尿均良好,除1例插管困难外余均能用16~20 F尿管自行导尿.去管折叠式贮尿囊39例,其中回肠贮尿囊3例、结肠22例、回结肠14例,能达到低压贮尿囊要求,但早期有8例发生贮尿囊过度扩张,容量1 470~1 650 ml;去带结肠贮尿囊8例,容量430~600 ml,充盈压30~45 cm H2O(1 cm H2O=0.098 kPa),有蠕动波,术后早期有2例尿漏.回肠新膀胱21例,容量350~460 ml,充盈压12~20 cm H2O,日间尿失禁1例,夜间尿失禁2例,其余无尿失禁. 结论盲升结肠30 cm剖开对折成形可控性膀胱可满足低压贮尿囊要求,去带结肠贮尿囊由于易发生术后尿漏或粘连,内压较高,不够理想.缩窄末段回肠式输出道控尿效果好、内腔大、插管顺利、并发症少,明显优于回肠套叠输出道.回肠新膀胱术贮尿排尿功能良好,术后生活质量高,但应严格选择手术适应证.
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