【摘要】 目的　改良回肠代膀胱成形方法 ,更好地解决膀胱全切术后贮尿和排尿问题。　方法　 2 0例膀胱癌患者行膀胱全切后 ,采用双U形方法作原位回肠代膀胱。于对系膜缘剖开肠管 ,肠片左右U形排列 ,连续缝合内侧缘 ;上下U形对折缝合成球形膀胱 ,上下U形缝合前行输尿管新膀胱再植和新膀胱尿道吻合。　结果　成形手术时间 (90± 15 )min。无严重并发症 ,无围手术期或术后早期死亡。术后随访 6～ 4 8个月 ,平均 2 5个月。患者控尿、排尿满意 ,2 0例 (10 0 % )白天控尿 ,夜间轻度尿失禁或遗尿 6例 (30 % ) ;1例男性患者出现排尿困难 ,行TUR解除。贮尿囊容量 2 5 0～ 4 5 0ml,平均 340ml,剩余尿 0～ 4 0ml。　结论　双U形回肠代膀胱术操作简便 ,新膀胱容量大、压力低 ,术后并发症发生率低。更多还原

【Abstract】 Objective To report the modified surgical technique currently used for the construction of an orthotopic ileal neobladder.So as to improve the vesical function of urinary storage and urination after total cystectomy. Methods Radical cystectomy and ileal neobladder with double “U” shape were performed in 20 patients with transitional cell carcinoma. After the detubularized ileal segment approximately 40 cm in length was arranged in a U configuration,the two medial borders of the U-shaped open segment were oversewn with a single layer seromuscular continuous 2-0 polyglycolic acid suture.The bottom of the U was folded over between the two ends of the U.Thus a spherical pouch, the neobladder, was fashioned. During that period, the neobladder anastomosed to the urethra.The ureters were implanted according to the improved stitching method. Results The operative time to form a neobladder was (90±15)min.Follow-up turned out that no perioperative or early postoperative mortality was observed, and no severe early complications occurred. The mean postoperative follow-up time was 25 (range,6 to 48) months.All the 20 cases achieved excellent continence except for 6 cases with temporary incontinence at night.Dysuria occurred in 1 case,and hydronephrosis on the left was found in 1 case.Six months later, the mean bladder capacity was 340 ml (range,250 to 450 ml). Conclusions The construction of an ileal neobladder using a smaller part of ileum that has been completely detubularized and fashioned by double U shape is easy and agreeable to perform.This mode of operation has low complication rates, achieves adequate capacity at low pressure, and provides satisfactory continence rates.更多还原