论文部分内容阅读
目的探讨保留勃起和射精功能的改良全膀胱切除术在膀胱良、恶性病变患者的临床应用价值。方法本组18例男性患者,年龄18~38岁,平均30.5岁。结核性挛缩膀胱4例,腺性膀胱炎5例,晚期神经原性膀胱5例,复发的多发性非肌层侵犯膀胱移行细胞癌4例,均需行全膀胱切除术,但患者强烈希望保留勃起和生育功能。行改良单纯性全膀胱切除术,保留输精管、精囊、前列腺和双侧神经血管束,以回肠新膀胱(13例)或回结肠新膀胱(5例)替代。结果平均手术时间350min,术中平均出血量420ml,7例患者输血。1例发生尿漏,无其他围手术期并发症。拔除导尿管后均能自行排尿,每次尿量300~500ml,剩余尿量25~65ml。2例神经源性膀胱患者需间歇自家导尿。白天无尿失禁,3例患者晚上有遗尿。平均随访46个月(18~68个月)。17例(94.4%)患者术后阴茎勃起功能恢复良好,均有遗精(未婚者)或顺行射精。尿路造影上尿路功能和新膀胱形态良好,1例轻度肾积水。肿瘤患者无复发。结论对选择性膀胱良、恶性病变患者行保留勃起和射精功能的改良全膀胱切除和原位膀胱术,安全有效,效果满意。尿动力学检查对神经源性膀胱患者的选择至关重要。
Objective To investigate the clinical value of modified total cystectomy with preserving erectile function and ejaculation in patients with benign and malignant bladder diseases. Methods 18 cases of male patients, aged 18 to 38 years, mean 30.5 years. 4 cases of tuberculous contracture bladder, 5 cases of cystitis glandularis, 5 cases of advanced neurogenic bladder, recurrent multiple non-muscular invasion of bladder transitional cell carcinoma in 4 cases, require cystectomy, but patients strongly hope to retain Erectile and reproductive function. A total cystectomy was performed, and the vas deferens, seminal vesicles, prostate and bilateral neurovascular bundles were reserved, and replaced with neo-ileum (13 cases) or neo-vesico-rectum (5 cases). Results The average operation time was 350 minutes. The average blood loss during operation was 420ml. Blood transfusions were performed in 7 patients. 1 case of urinary leakage, no other perioperative complications. Removal of the catheter can be self-urination, each urine output 300 ~ 500ml, the remaining urine output 25 ~ 65ml. 2 patients with neurogenic bladder need intermittent self catheterization. Urinary incontinence during the day, 3 patients had enuresis at night. The average follow-up of 46 months (18 to 68 months). Eighteen patients (94.4%) had good erectile function after operation, all with nocturnal emission (unmarried) or ejaculation. Upper urinary tract urinary tract function and neo-bladder morphology were good, 1 case of mild hydronephrosis. Tumor patients without recurrence. Conclusions The modified total cystectomy and orthotopic bladder operation with erectile function and ejaculation in patients with benign and malignant bladder lesions are safe and effective. Urodynamic tests are crucial for the selection of neurogenic bladder patients.