Urodynamic examination of orthotopic neobladder and reconstruction techniques for promoting urinary control
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摘要: 根治性膀胱全切术联合原位新膀胱是浸润性膀胱癌患者的最佳治疗选择。目前新膀胱术后功能评价标准尚不完善。尿流动力学检查作为评估膀胱功能的客观手段，在临床上应用广泛。完善标准化尿流动力学检查可对术后新膀胱的功能进行持续监测以指导管理，从而提高术后生活质量。理想的原位新膀胱应有适宜尿流率、足够的容量、残余尿少、低压、高顺应性、稳定、具有良好的排尿和控尿能力。针对保护排尿及控尿机制的重建技术，对于解决原位新膀胱术后新膀胱功能障碍至关重要。本文基于尿流动力学对原位新膀胱功能评价内容进行综述，并对促进尿控功能的重建技术加以总结，为临床治疗及术后功能评价提供参考。Abstract: Radical cystectomy combined with intestinal orthotopic neobladder has been regarded as the best treatment option for patients with invasive bladder cancer. However, postoperative functional evaluation is not enough presently. As an objective mean to evaluate the function of neobladder after surgery, urodynamic examination is widely used by clinicians to continuously monitor the orthotopic neobladder and provide management guidance, thus improving postoperative quality of life. The ideal neobladder should have satisfactory urinary flow rate, adequate bladder capacity, low residual urine, low pressure, high compliance, stability, effective urination and urinary control. Reconstruction techniques for protecting the mechanism of urination and urinary control are very important to solve the dysfunction of neobladder. In this paper, we reviewed the evaluations of neobladder function based on urodynamic examination, and summarized the reconstruction techniques to promote urinary control, which provided reference for clinical treatment.
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表 1 改善尿控功能的重建技术及目标效果
改善尿控功能的重建技术 目标效果 构建符合生理性解剖新膀胱 ①避免控尿过度；②促进新膀胱排尿功能 保留排尿相关神经支配 ①促进新膀胱控尿功能；②避免控尿过度；③避免膀胱尿道括约肌协同失调；④促进膀胱壁内牵张感受器的兴奋传导 保留尿道内在控尿功能 ①促进新膀胱控尿功能；②避免控尿过度 保留尿道支持组织 促进新膀胱控尿功能 保证新膀胱的解剖位置 ①促进新膀胱控尿功能；②避免控尿过度；③促进新膀胱排尿功能 
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