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目的比较胃、回肠原位代膀胱术后临床效果及并发症。方法回顾分析我科从2001年3月至2008年5月84例膀胱癌全膀胱切除+原位胃、回肠代膀胱术患者的临床资料、实验室检查、影像学检查、尿动力学检查、膀胱镜检查结果。其中,胃代膀胱44例,回肠代膀胱40例。结果随访4～78个月,所有患者经尿道排尿,未发生水、电解质、酸碱平衡紊乱,肾功能正常,无肾积水、输尿管扩张。胃代膀胱:容量290～530ml,平均395ml,排尿间隔时间2～4.8h,平均3.2h,最大尿流率12.8～26.2ml/s,平均18.4ml/s,充盈期膀胱压5～15cmH2O,平均10cmH2O;44例白天均能自控排尿,夜间遗尿8例,8例均出现不同程度尿道灼痛;残余尿10～110ml,平均36ml;尿pH4.5～6.7,平均5.8;尿路感染13例;膀胱镜检查见胃黏膜光滑平整、色泽稍苍白,未见溃疡。回肠代膀胱:容量350～550ml,平均426ml,排尿间隔时间2～4.6h,平均3.4h,最大尿流率13.5～26ml/s,平均18.8ml/s,充盈期膀胱压6～15cmH2O,平均10cmH2O,40例白天均能自控排尿,夜间遗尿5例,残余尿10～150ml,平均38ml,尿pH6.0～7.2;尿路感染35例次,其中4例拔除尿管后出现上尿路感染、高热。膀胱镜检见较多肠黏液,肠黏膜光滑平整、色泽稍苍白,未见溃疡。结论胃、回肠原位膀胱均能获得较满意的贮尿功能,多数患者术后能满意控尿。术后各相关生理指标基本正常。回肠代膀胱术后发生尿路感染明显多于胃代膀胱,胃代膀胱术后尿pH降低可致尿道灼痛。
Objective To compare the clinical effects and complications of anastomosis of the stomach and ileum after primary bladder replacement. Methods From March 2001 to May 2008, 84 cases of bladder cancer undergone total cystectomy + orthotopic stomach and ileal neobladder were retrospectively analyzed. The clinical data, laboratory examination, imaging examination, urodynamic examination, Mirror examination results. Among them, the stomach on behalf of the bladder in 44 cases, 40 cases of ileum on behalf of the bladder. Results All the patients were followed up for 4 to 78 months. All the patients had urethral voiding, no water, electrolyte, acid-base balance disorder, normal renal function, no hydronephrosis and ureteral dilatation. Stomach on behalf of the bladder: volume 290 ~ 530ml, an average of 395ml, urination interval 2 ~ 4.8h, an average of 3.2h, the maximum flow rate of 12.8 ~ 26.2ml / s, an average of 18.4ml / s, filling bladder pressure 5 ~ 15cmH2O, Urinary tract infection in 13 cases, urinary tract infection in 10 cases, urinary tract infection in 10 cases, urinary tract infection in 10 cases, Cystoscopy showed a smooth gastric mucosa, a little pale color, no ulcers. Ileal behalf of the bladder: the capacity of 350 ~ 550ml, an average of 426ml, voiding interval of 2 ~ 4.6h, an average of 3.4h, the maximum flow rate of 13.5 ~ 26ml / s, an average of 18.8ml / s, filling bladder pressure 6 ~ 15cmH2O average 10cmH2O , 40 patients were able to control urination during the daytime, nocturnal nocturnal enuresis in 5 cases, residual urine in 10 ~ 150ml, an average of 38ml, urine pH6.0 ~ 7.2; urinary tract infections in 35 cases, of which 4 cases of upper urinary tract infection after removal of the catheter, High fever. Cystoscopy see more mucus, intestinal mucosa smooth, slightly pale color, no ulcers. Conclusion Stomach and ileum in situ bladder can get more satisfactory urine storage function, most patients with satisfactory postoperative urinary control. After the relevant physiological indicators were normal. Urinary tract infection after ileal generation of bladder surgery was significantly more than the stomach on behalf of the bladder, urinary tract pH after gastric degeneration can cause urethral burning.