Clinical study on patients with preservation of erectile function and urinary continence undergoing laparoscopic radical cystectomy with Studer orthotopic ileal neobladder
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摘要: 目的:探讨腹腔镜Studer原位回肠新膀胱术保留阴茎勃起及控尿功能的方法及疗效。方法:对严格选择的要求保留勃起功能的46例男性膀胱癌患者行腹腔镜全膀胱切除、Studer原位回肠新膀胱术。常规手术组(A组):22例行常规腹腔镜膀胱前列腺全切除,术中注意保护神经血管束。常规建立Studer原位回肠新膀胱后与后尿道连续缝合。改良手术组(B组):24例在腹腔镜膀胱全切时保留耻骨前列腺韧带及前列腺尖部0.5~1.0 cm包膜,注意保护神经血管束等。重建Studer原位回肠新膀胱与尿道残端连续缝合,将前列腺尖部包膜及耻骨前列腺韧带缝合固定于新膀胱外壁。对两组术后的勃起功能及排尿、控尿功能等进行随访和比较。结果:手术均获成功。无一例中转开放手术。术后6个月随访,A组保留勃起功能者14例(63.6%),B组勃起功能保留者21例(87.5%),两组比较差异有统计学意义(P<0.05)。A组日间控尿率86.4%,夜间控尿率72.7%,尿失禁自我评价(ICIQ-SF)(9.2±3.8)分;B组日间控尿率91.7%,夜间控尿率83.3%,尿失禁自我评价(ICIQ-SF)(6.0±4.2)分。新膀胱尿流动力学检查A组最大尿流率(14±8) ml/s,剩余尿量(42.0±4.1) ml;B组最大尿流率(18±9) ml/s,剩余尿量(25.0±5.2) ml;两组比较,B组明显优于A组,但差异无统计学意义。结论:保留阴茎勃起及控尿功能的腹腔镜Studer原位回肠新膀胱术是一种较为理想的术式,疗效满意,值得临床推广。
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关键词:
- 膀胱癌 /
- 腹腔镜 /
- Studer原位回肠新膀胱 /
- 勃起功能 /
- 控尿功能
Abstract: Objective:To investigate the effect of patients with preservation of erectile function and urinary continence undergoing laparoscopic radical cystectomy with Studer orthotopic ileal neobladder.Method:Forty-six males with invasive bladder cancer were performed laparoscopic radical cystectomy with orthotopic ileal neobladder, and they asked for preservation of erectile function under strict selection. The patients were divided into two groups:classical cystectomy group (Group A, n=22) and modified cystectomy group (Group B, n=24). In group A, the bladder and prostate were excised thoroughly with neurovascular bundle preservation and the residual urethra was anastomosed with neobladder by continuous suture. In group B, the prostatic capsules were reserved with 0.5-1.0 cm distance from the apex and puboprostatic ligament. Reconstruction of orthotopic Studer ileal neobladder was anastomosed with the residual urethra by continuous suture. The capsule of the prostatic apex and puboprostatic ligament were sutured and fastened to the ektexine of the neobladder. A active follow-up was performed for all patients, including erectile function, urination and urinary continence.Result:All the operations were performed successfully without converting to open surgery. Fourteen patients (63.6%) in Group A had erectile function preservation while 21 cases (87.5%) in Group B retained erectile function, respectively. There was statistical significant difference between the two groups (P<0.05). The day-time and night-time urinary continence rate and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) scores of the two groups were 86.4%, 72.7% and (9.2±3.8) in Group A while 91.7%, 83.3% and (6.0±4.2) in Group B, respectively. Moreover, the maximum flow rate (Qmax) and residual urine volume of Group A and Group B were (14±8) ml/s vs. (18±9) ml/s and (42.0±4.1) ml vs. (25.0±5.2) ml, respectively. There was no statistical significant difference between the two groups (P>0.05).Conclusion: Laparoscopic radical cystectomy with orthotopic Studer ileal neobladder and simultaneous preservation of erectile function and urinary continence can be an ideal treatment method for its satisfactory effects, which is worthy to be popularized in the clinic. -
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