【摘要】 目的总结评价原位肠膀胱术的远期临床效果。方法对1989年1月至2001年12年问126例因膀胱癌行膀胱全切原位肠膀胱术的患者进行随访,收集资料进行分析。其中实行原位回肠代膀胱术84例,实行原位去带乙状结肠代膀胱术42例;术中行淋巴结清扫62例,术后放化疗64例。分别比较不同分组患者术后控尿率、并发症发生率、肿瘤复发率和5年生存率。结果获完整随访122例,乙状结肠组输尿管扩张及反流率高于回肠组(80.9%vs 32.1%,23.8 vs 2.4%,P<0.05),乙状结肠组夜问控尿率高于回肠组(P<0.05);清扫淋巴结组术后肿瘤复发率低于放化疗组(P<0.05),5年存活率高于放化疗组(P<0.05)。术后近期并发症发生率为15.9%(20/126),远期并发症发生率为9.8%(12/122)。结论原位肠膀胱术手术效果满意,术后并发症发生率低,术中行淋巴结清扫较术后放化疗能提高患者的5年生存率。更多还原

【Abstract】 Objective To evaluate the long-term clinical effects of orthotopic ileal or sigmoidocolic neobladder.Methods One hundred and twenty six patients with bladder cancer who underwent radical cystectomy and orthotopic ileal or sigmoidocolic neobladder from 1989 to 2001 were followed up,the clinical data was collected and analysed.Hautmann orthotopic ileal neobladder was performed on 84 cases and orthrotopic sigmoidocolic neobladder was performed on 42 cases;Lymphonode cleating during surgery was performed on 62 cases,chemotherapy and radiotherapy was performed on 64 cases after surgery.The continence and complications were compared between sigmoidocolic group and ileal group,the tumor recurrent rate and the 5-year survival rate were compared between lymphnode cleating group and chemoradical therapy group.Results Complete follow up was performed in 122 cases.Ureter broaden and urine backflow rate were higher in sigmoidocolic group than in ileal group(P<0.05),nocturnal continence rate in sigmoidocolic group was higher than in ileal group(P<0.05);Post-surgical tumor recurrent rate in lymphnode cleating group was lower than in chemoradical therapy group(P<0.05),the 5-year survival rate in lymphnode clearing group was higher than in chemoradical therapy group(P<0.05).The overall short- term complication rate was 15.9%(20/126),the overall long-term complication rate was 9.8%(12/122). Conclusion The effects of orthotopic ileal or sigmoidocolic neobladder were satisfactory with low complication rate,lymphnode cleating during the surgery can increase the 5-year survival rate when compared with the chemoradical group.更多还原