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目的探讨保留勃起和射精功能的全膀胱切除术对浸润性膀胱癌的疗效。方法收集2000年1月～2006年6月膀胱移行细胞癌19例,男性,平均年龄50.9岁,为保留性功能,改善控尿,行改良根治性全膀胱切除原位回肠新膀胱术,保留精囊、输精管、双侧神经血管束及大部分前列腺包膜,随访观察手术效果和生活质量。结果术后病理报告T2aN0M013例,T2bN0M06例。平均随访39个月(6～78个月),死亡率0,均未发现局部及远处转移;平均手术时间5h,平均出血400ml;白天控尿率100%(19/19),夜间尿失禁10.5%(2/19);全部患者均保留勃起及逆行射精功能,IIEF-5平均22分;新膀胱储尿囊容量350～480ml,充盈压13～25cmH2O,残余尿量10～60ml。结论对有选择的病例采用保留性功能的全膀胱切除-原位回肠新膀胱术可以更好的保留阴茎勃起射精及控尿功能。
Objective To investigate the curative effect of total cystectomy with erectile function and ejaculation on invasive bladder cancer. Methods Twenty-nine cases of bladder transitional cell carcinoma were collected from January 2000 to June 2006. The average age was 50.9 years old. To preserve the function and improve the control of urine, a total radical nephrectomy was performed with modified radical cystectomy. , Vas deferens, bilateral neurovascular bundles and most of the prostate capsule were followed up to observe the effect and quality of life. Results Postoperative pathology T2aN0M013 cases, T2bN0M06 cases. The average follow-up time was 39 months (range, 6 to 78 months) with a mortality rate of 0, and no local or distant metastasis was found. The average operation time was 5 hours and the average bleeding was 400ml. The daytime urine control rate was 100% (19/19) 10.5% (2/19). All patients had erectile function and retrograde ejaculation. The average score of IIEF-5 was 22 points. The volume of new bladder was 350 ~ 480ml. The filling pressure was 13 ~ 25cmH2O and the residual urine volume was 10 ~ 60ml. Conclusions Total cystectomy with reserved function in selected cases - neointima of the ileum in situ can better preserve penile erection and urine control.