【摘要】 目的 :评价改良全膀胱切除方法和原位回肠新膀胱术的临床疗效。方法 :对 12例膀胱癌患者行改良全膀胱切除术 ,顺行分离膀胱顶部、侧壁上半部、底部 ,切断输尿管后改逆行分离。示指紧贴前列腺包膜将前列腺与直肠分开后 ,向上向外将膀胱颈部侧韧带和精囊尾的纤维束钩于示指掌握之中 ,切断并结扎。女性患者保留内生殖器及尿道内口。尿流改道采用原位回肠新膀胱术 ,并就手术并发症、术后控尿排尿情况、新膀胱容量、影像学和生化检查进行随访 ,随访时间 8～ 6 2个月 ,平均 35个月。结果 :切除膀胱时间平均 80min ,术中平均出血 4 5 0ml。原位回肠新膀胱控尿、排尿良好 ,术后静脉尿路造影、B超检查未见上尿路扩张 ,膀胱造影未发现输尿管反流 ,血生化检查正常 ,未发现新膀胱或尿道肿瘤复发。结论 :改良膀胱切除术 原位回肠新膀胱术是治疗浸润性膀胱癌的理想方法。更多还原

【Abstract】 Purpose:To evaluate the modified technique of total cystectomy and the clinical effect of ileal orthotopic neobladder for bladder tumor.Methods:A modified technique of total cystectomy was carried out in 12 patients with bladder tumor. The dome, bilateral upper wall and base of bladder were detached in sequence.After cutting the ureters, the bladder was detached retrogradely. After the back of prostate was separated from rectum with forefinger, cut and ligated the lateral ligament of bladder and the fasciculus of spermatophore which were detached upward and outward by forfinger. The uterus and vagina were reserved in female patients.An neobladder was constructed using an ileal segment with a "W" type. All patients had been followed up ,including the operational complications ,the urine incontinence, the capacity of the neobladder, Intravenous Urography (IVU), B ultrasound and biochemistry examination. The time of following up was from 8 to 62 months with a mean of 35 months.Results:The cystectomy takes 80 minutes on average with a mean bleeding volume of 450ml. The patients have excellent urine control and micturition. Patient with hydrocele of upper urinary tract was not found by BUS and IVU. Voiding cystography revealed no patient with ureterovesical reflux. Renal function, electrolyte and other laboratory findings were normal. No patient suffered from tumor recurrence in neobladder or urethral.Conclusion:The modified technique of total cystectomy and orthotopic ileal neobladder was an ideal methods for treatment of invasive bladder tumor.更多还原