目的 研制贮存和排出尿液功能近似正常膀胱的原位膀胱重建新术式。方法 用末段回肠30 cm,乙醇浸泡肠粘膜,N形排列去管后制成球形贮尿囊。输尿管与贮尿囊行抗返流吻合,贮尿囊下端与尿道断端吻合。临床应用38例。结果获得随访38例,随访时间3-42(平均32)月。37例健在。排尿可控率100％。术后12月20例平均尿量585.6 mL/次。残余尿22 mL。Qmax17.3ml·s-1。膀胱测压18例,平均半充盈、充盈和排尿压力分别为1.18、1.62、4.60kPa。尿常规正常,尿培养(-);肾功能及血生化正常。无肾、输尿管积水。病理示新膀胱粘膜变薄,粘膜腺体减少,绒毛消失,部分区域固有膜腺体消失,呈鳞状化生结构。PAS、HSP阳性,p53阴性。结论 球形可控回肠原位膀胱术具有容量大、压力低、可控性好,对机体干扰轻,并发症少,易接受等优点。 Objective To develop a new method of orthotopic bladder reconstruction with normal bladder function by storing and discharging urine. Methods The terminal ileum 30 cm, ethanol soaked intestinal mucosa, N-shaped arranged to tube after the ball-shaped storage of urine. Ureter and stool anti-retrograde anastomosis, storage of the lower end of the urethra and urethral stump anastomosis. Clinical application of 38 cases. Results 38 cases were followed up for 3-42 months (average 32 months). 37 cases of health. Urination control rate of 100%. Postoperative December 20 cases of the average urine output of 585.6 mL / time. Residual urine 22 mL. Qmax 17.3ml · s-1. Bladder pressure in 18 cases, the average semi-full filling, filling and voiding pressure were 1.18,1.62,4.60 kPa. Urine routine, urine culture (-); normal renal function and blood biochemistry. No kidney, ureteral hydrops. Pathology showed a thinning of the new bladder mucosa, mucosal glands reduced villous disappear, some areas of the intrinsic membranous glands disappear, were squamous metaplasia structure. PAS, HSP positive, p53 negative. Conclusions Spherical ileocolic bladder surgery has the advantages of large capacity, low pressure, good controllability, less interference to the body, fewer complications and easy to accept.