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目的探讨根治性膀胱切除原位新膀胱术后新膀胱尿道吻合口狭窄的诊断和治疗效果。方法回顾性分析416例男性膀胱尿路上皮癌行根治性膀胱切除原位新膀胱术患者的临床资料,分析新膀胱尿道吻合口狭窄的发生率及其诊断和治疗。结果本组共15例(3.6%)发生新膀胱尿道吻合口狭窄,Ⅰ级狭窄(17F~22F)5例,Ⅱ级狭窄(<17F)8例,Ⅲ级狭窄(针尖)2例。9例表现为排尿困难,3例表现为尿潴留,2例表现为泌尿系感染,1例表现为初发的充盈性尿失禁。7例初始行尿道探子或尿道镜扩张,其中2例无效改行经尿道狭窄钬激光或冷刀切开术,均恢复排尿通畅;3例初始即行经尿道狭窄钬激光或冷刀切开术,均恢复正常排尿;5例初始行单次或多次经尿道瘢痕切除术,4例能排空新膀胱,1例无效行新膀胱腹壁造瘘术。所有患者治疗后均定期随访,平均随访56个月,14例完全排空新膀胱,无患者出现新发的尿失禁。结论原位新膀胱术后新膀胱尿道吻合口狭窄发生率较低,主要表现为排尿困难,尿道扩张和腔内治疗是有效的微创治疗手段,大部分患者能获得满意的疗效。
Objective To investigate the diagnosis and treatment of anastomotic stenosis of neovaginal bladder and urethra after radical cystectomy in situ. Methods A retrospective analysis of 416 cases of bladder urothelial carcinoma patients undergoing radical cystectomy in situ neobladder in patients with clinical data, analysis of the incidence of anastomosis of the new bladder and urethra and its diagnosis and treatment. Results There were 5 cases of grade Ⅰ stenosis (17F ~ 22F), 8 cases of grade Ⅱ stenosis (<17F) and 2 cases of grade Ⅲ stenosis (tip) in 15 cases (3.6%) in this group. Nine cases showed dysuria, three cases showed urinary retention, two cases showed urinary tract infection, and one case presented with initial incontinence. 7 cases of initial urethral probe or urethral dilatation, of which 2 were ineffective diverting transurethral holmium laser or cold knife incision were to restore voiding patency; 3 cases of initial urethral stenosis holmium laser or cold knife incision, were Normal urination was resumed in 5 cases. One or more transurethral scar resections were performed initially in 5 cases, 4 cases were able to empty the bladder and 1 case was failed to perform neovarian abdominal wall ostomy. All patients were followed up regularly for a mean follow-up of 56 months. 14 patients had completely emptying the bladder and no new urinary incontinence occurred. Conclusions The incidence of anastomotic stenosis of new vesicourethral urethra after in-situ neobladder is low. The main manifestations are dysuria, urethral dilatation and endovascular treatment are effective minimally invasive treatment. Most patients can obtain satisfactory curative effect.