全膀胱切除正压可控低压U型回肠代膀胱术101例临床分析
膀胱肿瘤,,膀胱肿瘤；癌；手术；尿流改道,1资料与方法,2结果,3讨论,【参考文献】
【摘要】 目的 全膀胱切除是浸润性膀胱癌和多发性膀胱癌的标准治疗方法，不同尿流改道方式对生活质量影响差别很大。为解决全膀胱切除后贮尿、控尿和排尿问题，本文总结正压可控性低压U型回肠代膀胱术的手术经验。方法 1994年6月～2005年1月共施行了101例全膀胱切除正压可控性低压U型回肠代膀胱术。回顾性分析这些患者的临床资料，总结该方法的手术指征和临床效果。结果 101例手术顺利，无手术死亡。手术时间为4～6.5h，平均5h，随访3～48个月，平均30个月，101例U型回肠膀胱均能自行排尿，其中96例(95.0%)白天完全控尿，69例(68.3%)昼夜完全控尿，32例(31.7% )夜间尿失禁。术后无并发症，随访期内无肿瘤复发，死亡3例，1例于术后9天死于手术后急性心肌梗死，2例于术后2年死于脑出血。结论 对浸润性膀胱癌和多发性膀胱癌应尽早行全膀胱切除，正压可控性低压U型回肠代膀胱术，操作简单、安全、可靠，术后生活质量提高，且远期效果良好，值得临床广泛应用。【关键词】 膀胱肿瘤；癌；手术；尿流改道
Report on 101 cases of total cystectomy U-type continent ileal reservoir with low pressure as replacement of urinary bladder
LIU Zhi-ming,LIU Fa-gang,XIN Jian-wei,et al.
Department of Urology,Gaomi Peoples Hospital,Shandong 261500,China
【Abstract】 Objective Total cystectomy U-type continent ileal reservoir with low pressure as replacement of urinary bladder is the standard treatment for invasive bladder cancer and multiple bladder cancer. Different mode of urinary diversion affects peoples life quality on different degree. In order to solve the problem of urine reservation, controlling and voiding after total cystectomy, we report our experience on U-type continent ileal reservoir with low pressure as replacement of urinary bladder. Methods From June 1994 to January 2005, 101 cases of total cystectomy U-type continent ileal reservoir with low pressure as replacement of urinary bladder were performed. Indications and effects of this methods clinical outcome were analyzed.Results Operations were successful in 101 cases and postoperative mortality was zero. Operative time was 4～6.5 hours, averaging 5 hours. The follow up was 3～48 months, averaging 30 months. 101 patients with U-type bladder voided well and 96(95.0%) patients of them were continent in the daytime, 69(68.3%) patients were continent at night, 32(31.7%) patients were incontinent at night. There were no complications in these patients. 3 patients died, 1 patient died of acute myocardial infarction 9 days after operation, 2 patients died of cerebral haemorrhage 2 years after operation.Conclusion Total cystectomy U-type continent ileal reservoir with low pressure as replacement of urinary bladder should be done early for patients with invasive bladder cancer and multiple bladder cancer. With its feature of simple, safe and stable, it can improve life quality after operation and worth promoting widely. ......
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