改良原位螺旋构型回肠新膀胱术后并发症及其防治（附32例报告）

陈煜; 王伟高; 钟欢; 李辉; 俞彬; 汤建儿; 金晓东

doi:10.13201/j.issn.1001-1420.2017.06.014

改良原位螺旋构型回肠新膀胱术后并发症及其防治（附32例报告）

- 1. 浙江省湖州市第一人民医院泌尿外科(浙江湖州, 313000);
- 2. 浙江大学附属第一医院泌尿外科
基金项目:
浙江省医药卫生科技项目(编号2016KYB280)

详细信息

通讯作者: 金晓东,E-mail:kingshoulder@163.com

中图分类号: R737.14;R699.5

收稿日期: 2016-12-19

Prevention and treatment of complications of modified spiral ileal orthotopic neobladder（Report of 32 cases）

- 1. Department of Urology, First People's Hospital of Huzhou, Huzhou, Zhejiang, 313000, China;
- 2. Department of Urology, First Affiliated Hospital of Zhejiang University

More Information

Corresponding author: JING Xiaodong, E-mail: kingshoulder@163.com

Received Date: 19 December 2016

摘要

摘要: 目的:探讨改良原位螺旋构型回肠新膀胱术后并发症的发生及防治。方法:我院1998年1月~2008年1月对32例男性膀胱癌患者施行了原位螺旋构型回肠新膀胱术。新建的储尿囊采用40~45cm回肠去管后行无水乙醇反复擦拭以清除、破坏黏液细胞,并螺旋状构型缝合成低压储尿囊。两侧输尿管末端袖口状整形后分别行原位“插入式”置入新膀胱(Split-Cuff术式)。新建储尿囊采用“四针法”低位与尿道缝合。结果:本组早期并发症中,腹泻是最常见的并发症,共7例(21.9%),其次是尿路感染6例(18.8%),夜间尿失禁6例(18.8%),漏尿3例(9.4%),白天尿失禁2例(6.3%);在远期并发症中,尿路感染9例(32.1%),原6例夜间尿失禁患者中2例好转,夜间尿失禁4例。腹泻症状大多好转,轻度腹泻2例(7.1%),肿瘤复发4例(14.2%),贮尿囊结石1例(3.6%),回肠尿道吻合口狭窄1例(3.6%)。结论:我们构建的改良原位螺旋构型回肠新膀胱术后疗效可靠,同时并发症的发生率和其他构型的原位新膀胱术相当。限于随访时间和病例数有限,并发症发生率有待进一步完善。
- 膀胱肿瘤 /
- 尿流改道术 /
- 螺旋构型 /
- 并发症
Abstract: Objective:To assess prevention and treatment of the complications of our modified spiral ileal orthotopic neobladder with orthotopic ureteral reimplantation.Method:From January 1998 to January 2008, 32patients (all men) underwent radical cystectomy and spiral ileal orthotopic substitution for muscle invasive bladder cancer.A segment of 40 to 45cm ileal loop was isolated, detubularized, and reconfigured in spiral shape to form a pouch.Bilateral ureters were reimplanted orthotopically by means of inserting the 1cm distal segment into the pouch to form split-cuff nipple.The bottom of pouch was opened and anastomosed with the urethra (4stitches). Result:Early postoperative complications:the most common complication was diarrhea in seven (21.9%) patients, followed by urinary tract infection in six (18.8%) , urinary nighttime incontinence in six (18.8%) , urine leakage in three (9.4%) and urinary daytime incontinence in two (6.3%). Late postoperative complications:the most common complication was urinary tract infection in nine (32.1%). Two patients in six patients with urinary nighttime incontinence improved.Most patients with diarrhea got better or recovered, but only two patients had mild diarrhea (7.1%). Tumor recurrence was found in four (14.2%) cases.Urinary pouch stones was found in only one (3.6%) , while ileo-urethral stenosis was found in one (3.6%). Conclusion:We describe a modified orthotopic ileal neobladder:the spiral ileal.The functional results with this pouch are good.Complication rates are comparable with the larger series published by other authors, using different ileal neobladder reconstructions.Because of short-term follow-up and a limited number of patients, the procedure needs further improvement.
- bladder neoplasms /
- urinary division /
- spiral /
- complications

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