膀胱癌根治术后T型回肠新膀胱术的临床应用

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1、膀胱癌根治术后T型回肠新膀胱术的临床应用作者：陈宇东王强刘伟英王领军史建国王志鹏邢念【摘要】目的探讨膀胱癌根治术后T型回肠新膀胱术的手术方法及临床应用价值。方法对25例膀胱癌患者施行T型回肠新膀胱术：截取一段54cm左右的回肠，利用远端的44cm肠管做成储尿囊，而近端的10cm肠管作为新膀胱的输入禅，并通过将输入禅远端的5cm肠管包埋于构成储尿囊两肠管之间的浆膜隧道内而形成抗返流机制。结果25例手术经过顺利，术后3周拔除尿管后均能自控排尿，尿量为50〜200mlo术后3个月复查尿常规无异常，肾功能及电解质无异常。尿动力学检查，新膀胱最大容量为(327.3±62.7)ml,最大

2、尿流率为(16.2±7.9)ml/s,充盈期膀胱内压力为0〜8cmH2O,排尿期膀胱内压力为8〜16cmH2O,剩余尿为0-40mlo静脉肾盂造影或B超检查，结果表明无肾积水、无输尿管扩张。膀胱造影未见输尿管返流。结论原位T型回肠新膀胱术具有良好的可操作性、较好的尿控及排尿能力，是一种良好的尿流改道术，值得临床推广应用。【关键词】膀胱肿瘤；尿流改道；新膀胱术【Abstract]ObjectiveToexploretheoperationmethodanditsclinicalapplicationvalueofTpouchilealneobladderoperationaft

3、ertheradicalcorrectionofcarcinomaofbladder.Methods25patientswithcarcinomaofbladderwereperformedoftheileumwasusedtoconstructtheTpouch.Thedistal44cmileumwasusedtoformthereservoir,whiletheproximal10cmileumwasusedtoformtheafferentantirefluxmechanismbyTpouchilealneobladderoperation.54cmterminalp

4、ortionilealsegmentintotheanchoringthedistal5cmafferentserosal1inedilealtroughformedbythebaseofthe2adjacentilealsegments.ResultsAlltheoperationsturnedtobesmoothduringthesurgery.25patientswereabletovoidcompletelyafterpullingoutthecatheter3weekspostoperatively.Theurinevolumewasfoundtobe50to200

5、mLThepatientscamebacktothehospitalforroutineexamination3monthsaftersurgery.Theirurinalysisandrenalfunctionwerenormalandtherewasnoelectrolytedisorder.Themaximumcystometriccapacitywas(327.3±62.7)mlandthemaximumf1owratewas(16・2±7.9)ml/s.Thebladderpressurewas0to8cmH20duringfillingphasewhile8to1

6、6cmH20duringvoidingphase,andtheresidualurinewasfrom0to40m1.TherewerenohydronephrosisanddilationofuretersthroughtheexaminationofexcretoryurographyandBultrasound.Cystographyshowednourinaryreflux.ConclusionTheorthotopicTpouchilealneobladderoperationwhichisafeasibleandgoodurinarydiversionwithgo

7、odvoidingabi1ityandcontinenceisworthspreadingandapplying.[Keywords]Bladdertumor;Urinarydiversion;Neobladder膀胱癌根治术后尿流改道正从简单的回肠或结肠通道术向原位新膀胱术转变，因为一个成功的原位新膀胱（膀胱替代）能够解决患者的储尿与排尿问题，患者无需佩带尿袋，大大提高了患者的生活质量。2005年3月〜2008年2月，我们对25例膀胱癌患者行全膀胱切除术后T型回肠原位新膀胱术，效果满意。1资料与方法1