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目的:探讨膀胱全切术后理想的膀胱替代术式。方法:采用回肠折叠成“W”形或“U”形贮尿囊与尿道吻合,尿液经原尿道排出的正位回肠膀胱重建术治疗膀胱全切术患者26例。结果:围术期无一例死亡,随访0.5～2.5年,膀胱容量220～460 ml,平均380 ml;膀胱充盈压1.27～4.41 kPa(平均2.94 kPa);最大尿流率1 2～20 ml/s(平均18 ml/s);新膀胱排尿功能良好;3例出现上尿路积水,间断自我导尿后好转;血电解质显示7例患者血清Cl-偏高,但无酸中毒发生,血清肌酐、尿素氮均在正常范围。结论:正位回肠膀胱重建术是较理想的膀胱替代术式。
Objective: To investigate the ideal bladder replacement after total cystectomy. Methods: Twenty-six cases underwent total bladder resection with ileal folds into “W” shape or “U” shape urinary bladder anastomosed with the urethra and urinary excretion through the urethra. Results: During the perioperative period, none of the patients died. The follow-up ranged from 0.5 to 2.5 years. The bladder volume was 220-460 ml with an average of 380 ml. The bladder filling pressure ranged from 1.27 to 4.41 kPa (average 2.94 kPa) (Average 18 ml / s); urinary bladder function was good; upper urinary tract was found in 3 cases and intermittent self-catheterization was improved; serum electrolytes showed high Cl- in serum but no acidosis, serum creatinine , Urea nitrogen are in the normal range. Conclusion: Posterior ileal bladder reconstruction is an ideal bladder replacement surgery.