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目的 总结女性膀胱全切患者行原位尿流改道的临床疗效。 方法 回顾性分析1995年9月至2003年12月34例女性膀胱全切、原位尿流改道患者的临床资料。34例患者,年龄53~64岁,平均58岁。其中移行细胞癌30例,腺癌3例,鳞状上皮癌1例。原发肿瘤30例,复发肿瘤4例。34例患者均行膀胱全切,其中24例保留自主神经。所有患者均截取末段回肠,行回肠代膀胱。术后随访观察临床效果。 结果 34例手术时间平均360min(280~420min),输血量平均600ml(300~1000ml)。术后30例获随访,随访6~108个月,平均61个月。术后6个月昼夜控尿率分别为90% (27 /30)和86% (26 /30)。一次性排空膀胱23例, 2例排尿可控过度,需定时导尿,另5例需采用手压下腹部排空新膀胱。23例行尿动力检查结果显示:贮尿囊容量300~520ml,充盈期囊内压<23cmH2O(6~23cmH2O, 1cmH2O=0. 098kPa),最大尿道压35 ~70cmH2O,功能性尿道长2. 6~3. 5cm,剩余尿量0~38ml。IVU检查贮尿囊球形,无输尿管狭窄,轻度输尿管返流1例,肾盂输尿管轻度扩张1例。血电解质和肾功能正常.无肠膀胱或尿道残端复发者。 结论 女性膀胱癌患者行原位尿流改道可获得满意的临床效果,可作为该类患者的首选治疗方法。
Objective To summarize the clinical curative effect of primary urinary diversion in patients undergoing total bladder resection. Methods The clinical data of 34 cases of female bladder total incision and orthotopic urinary diversion from September 1995 to December 2003 were retrospectively analyzed. 34 patients, aged 53 to 64 years, mean 58 years. Including transitional cell carcinoma in 30 cases, adenocarcinoma in 3 cases, squamous cell carcinoma in 1 case. 30 cases of primary tumor, recurrent tumor in 4 cases. Totally 34 patients underwent complete resection of the bladder, 24 of them retained the autonomic nerve. All patients were intercepted the distal ileum, ileal behalf of the bladder. Follow-up observation of clinical effect. Results The average operation time of the 34 cases was 360min (280 ~ 420min) and the average transfusion volume was 600ml (300 ~ 1000ml). After the operation, 30 cases were followed up for 6 to 108 months with an average of 61 months. The diurnal urine control rates at 6 months after surgery were 90% (27/30) and 86% (26/30), respectively. One-time emptying of the bladder 23 cases, 2 cases of urinary control overdose, need to be timed catheterization, the other 5 cases need to hand pressure the abdomen to empty the bladder. Twenty-three routine urodynamic tests showed that the capacity of the storage vessels was 300-520ml, the filling pressure was less than 23cmH2O (6-23cmH2O, 1cmH2O = 0.098kPa), the maximum urethral pressure was 35-70cmH2O and the functional urethra length was 2.6 ~ 3. 5cm, remaining urine volume 0 ~ 38ml. In IVU, the ureteral pelvis was spherical, ureteric stenosis was not found, mild ureteral reflux was found in 1 case and pelvis ureter was slightly expanded in 1 case. Blood electrolytes and normal renal function. No intestinal bladder or urethral stump recurrence. Conclusion Female urinary bladder cancer patients with in situ urinary diversion can obtain satisfactory clinical results, which can be used as the preferred treatment for such patients.