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目的 探讨全膀胱切除术中保留远端部分前列腺外科包膜及其周围横纹括约肌对原位新膀胱功能的影响。 方法 对 2 3例男性膀胱癌患者行全膀胱切除并肠道原位新膀胱术。分两组 :①改良手术组 :13例 ,在膀胱切除时保留远端部分前列腺外科包膜及其周围横纹括约肌 ,新膀胱与残留前列腺包膜连续缝合 ;②常规手术组 :10例 ,行常规全膀胱切除 ,新膀胱与后尿道间断缝合。对两组新膀胱术后的控尿和排尿功能进行随访和比较。 结果 术后病理分期 :T2aN0 M0 13例 ,T2bN0 M0 6例 ,T1N0 M0 1例 ,T3aN0 M0 1例 ,T3bN1M0 1例和T4aN0 M0 1例。术后随访 3～ 4 0个月。改良手术组无瘤生存 11例 ;带瘤生存 2例 ,其中 1例为低分化移行细胞癌 ;另 1例为低分化腺癌。 13例新膀胱排尿良好 ,剩余尿 0～ 70ml;完全控尿 12例 ,夜间尿失禁 1例。常规手术组 10例均无瘤生存 ,7例排尿好 ,剩余尿 10～ 10 0ml,3例剩余尿 10 0～ 2 5 0ml,需要不定期间歇导尿 ;完全控尿 7例 ,昼夜尿失禁 1例 ,夜间尿失禁 2例。 结论 保留部分前列腺外科包膜及其周围横纹括约肌可改善原位新膀胱术后患者的排尿和控尿功能。
Objective To investigate the effect of preserving the distal part of prostate surgical capsule and its surrounding striated sphincter on the function of in situ neobladder during total cystectomy. Methods Twenty-three male bladder cancer patients underwent total cystectomy and enteral neo-neo-bladder surgery. Divided into two groups: ① modified surgery group: 13 cases, retaining the distal part of the prostate surgical capsule and its surrounding striated sphincter during cystectomy, the new bladder and residual prostate capsule continuous suture; ② conventional surgery group: 10 cases, line Conventional total cystectomy, intermittent suture between the new bladder and the posterior urethra. Follow-up and comparison of the control and urination functions of the two groups after neo-bladder surgery. Results There were 13 cases of T2aN0 M0, 6 cases of T2bN0 M0, 1 case of T1N0 M0, 1 case of T3aN0 M0, 1 case of T3b N1 M0 and 1 case of T4aN0 M0. The patients were followed up for 3 ~ 40 months. In the modified surgery group, there were 11 cases with no tumor, 2 cases with tumor survival, 1 case with poorly differentiated transitional cell carcinoma and 1 case with poorly differentiated adenocarcinoma. Thirteen new cases of urinary bladder urination, residual urine 0 ~ 70ml; complete control of urine in 12 cases, night urinary incontinence in 1 case. In the conventional operation group, 10 cases had no tumor, 7 cases had good urination, 10-10 ml residual urine and 3 cases residual urine 10 0-250 ml, which required intermittent catheterization; 7 cases were completely controlled by urine, 1 case had diurnal urinary incontinence 1 Cases, night urinary incontinence in 2 cases. Conclusion Retaining some of the prostate surgical envelop and its surrounding striated sphincter can improve urinary and urine control in patients with neo-bladder surgery.