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目的 :探索全膀胱切除术后保留较好生活质量的手术方法。方法 :改良方法行全膀胱切除术 ,术中保留膀胱外括约肌及膜部尿道。取约 6 0cm带血管蒂的末段回肠 ,于肠系膜对侧缘纵形剖开形成肠片 ,再将该肠片以“W”形折叠 ,缝合为球形的新膀胱。双侧输尿管断端吻合于球形新膀胱 ,新膀胱的底部与尿道残端吻合。结果 :31例中 2 8例术后控排尿功能好 ,每次排尿量 2 0 0～ 6 0 0ml;3例患者术后排尿困难 ;无尿失禁病例。所有患者术后血电解质基本正常。B超检查无肾、输尿管扩张积水。膀胱造影无膀胱输尿管返流。膀胱镜检查无尿道肿瘤复发。结论 :回肠新膀胱术后有良好的排尿功能。膀胱容量大 ,压力低 ,自控排尿功能好 ,术后并发症少 ,是浸润性膀胱癌手术方式的一个优良选择
Objective: To explore the method of operation to preserve the quality of life after total cystectomy. Methods: A total cystectomy was performed in the modified method. The bladder external sphincter and membranous urethra were preserved during operation. Take about 60cm vascularized distal ileum, longitudinally open on the side of the mesentery to form a bowel, and then the bowel in a “W” -shaped, sutured into a new spherical bladder. Bilateral ureteral end anastomosis spherical new bladder, the bottom of the new bladder and urinary stump anastomosis. Results: Twenty-eight of 31 cases had good postoperative urinary control, with a volume of 200 to 600 ml. The urination difficulties of three patients and no cases of urinary incontinence were observed. Blood electrolytes were normal in all patients. B ultrasound examination without kidney, ureteral expansion of water. Bladder contrast without vesicoureteral reflux. Cystoscopy without urethral tumor recurrence. Conclusion: There is good urinary function after neo-ileal surgery. Large bladder capacity, low pressure, good self-control urination, less postoperative complications, is an excellent choice for invasive bladder cancer surgery