根治性膀胱全切原位膀胱术远期临床分析(附32例报告)-外科学专业论文.docx

- - PAGE 1 - 摘 要 根治性膀胱全切原位膀胱术远期临床分析 （附 32 例病例报告） 研究生：波拉提·沙依提 导师：王玉杰 副教授 摘 要 目的：探讨回肠或结肠原位新膀胱术的远期临床疗效。方法：膀胱肿瘤患者 32 例，其中男性 28 例，女性 4 例；年龄 20～77 岁，平均 59 岁。均采用膀胱全切术后， 应用末段回肠或乙状结肠做新膀胱行正位膀胱重建术。结果：32 例患者中获得随访 29 例，失访 3 例（9.4%），随访时间 3～36 个月，平均 17.9 个月。患者一般于术后 三个月恢复可控性排尿，白天可控排尿 23 例（92%），12 例出现夜间尿失禁（48%）； 20 例患者术后 6 个月行尿动力学检查新膀胱容量（378±57）ml，最大尿流率（14.9±1.3） ml/s，残余尿量（26±8）ml；输尿管返流 2 例，输尿管狭窄 2 例，无尿道狭窄，无尿 道肿瘤复发；术后 3 个月及 6 个月复查血常规，血电解质均在正常范围内，无高氯 性酸中毒，肾功能正常。1 例在围手术期因肠吻合口漏至感染性休克，多器官功能衰 竭而死亡；随访期间 1 例因术后一年化疗时出现颅内感染死亡；1 例因术后两年时肿 瘤盆腔多发转移死亡，余均无瘤存活。结论：回肠或结肠代膀胱术具有新膀胱容量 大、内压低，正位排尿、可控性好、并发症少等特点，明显地提高患者的术后生活 质量，患者易于接受，是一种比较理想的手术方式。 关键词：膀胱肿瘤； 根治性膀胱切除术； 尿流改道 新疆医科大学医学硕士学位论文 The evaluate of long-term clinical effects of radical cystectomy with orthotopic ileal and colonic neobladder (A series of 32 cases) Postgraduate: BoLaTi. ShaYiTi Supervisor: Prof. Wang YuJie Abstract Objective: To evaluate the orthotopic ileocolon continent urinary reservoir after radical cyctectomy for managing bladder cancer. Methods: 32 patients with bladder cancer (28 males and 4females; age range from 20 to 70 years), all managed by the orthotopic ileocolon continent urinary reservoir after radical cyctectomy were reviewed and evaluated. Results: Of the 32 patients, 29 were followed up for 6 to 36 months (mean, months). No serious operation related complications occurred. The daytime urinary continence rate was 92%; Urodynamics was carried out at 6 months after operation, It was showed that the average capacity of the urinary reservoir. the peak flow rate and postvoid residual were 386ml, 12.5ml/s and 26ml respectively. Ureteral reflux occurred only in 2 cases and ureteral stricture occueeed in 2 cases, but no evidences of urethral stricture and no hyperchloremic acidosis have been observed. Conclusions: Orthotopic ileocolon continent urinary reservoir might be considerd as an ideal from of urinary diversion, characterized by low pressure, large capacity, orthotopic and continent urination. Key words: Bladder carcino