摘要目的 观察根治性膀胱切除原位W形回肠代膀胱术后36个月内尿动力学参数变化特点. 方法 肌层浸润膀胱癌行根治性膀胱切除原位W形回肠代膀胱术患者45例,分别于术后12、36个月行尿动力学检查和随访.尿动力学检测内容包括尿流率、膀胱容量、顺应性、压力/流率、残余尿量,临床随访项目包括泌尿系B超、IVU、膀胱造影和血清肾功能电解质检查. 结果 45例患者中1例因吻合口瘘致感染性休克,多器官衰竭死亡,2例因肿瘤复发转移死亡,其余42例患者术后第12个月和36个月最大尿流率分别为(15.6±2.3)和(14.9±1.9)ml/s,膀胱容量分别为(588.0±264.6)和(561.0±197.4) ml,顺应性分别为(27.6±8.4)和(29.5 ±1.7)ml/cm H2O,充盈期最大膀胱压分别为(24.4±5.2)和(33.0 ±6.8)cm H2O,排尿期最大膀胱压分别为(60.7±18.0)和(79.9±28.2)cm H2O,残余尿量分别为(83.5±24.4)和(80.4 ±26.8)ml,术后第12个月和第36个月充盈期、排尿期最大膀胱压比较差异有统计学意义(P＜0.05).白天控尿率分别为90％和94％,夜间控尿率分别为48％和74％. 结论 根治性膀胱切除原位W形回肠代膀胱具有较大的膀胱容量、低压储尿和较好的排尿功能特点,是一种较理想的尿流改道方式.

abstractsObjective To evaluate the urodynamic parameters of W shape orthotopic ileal neobladder during a 36-month follow-up post-operatively.Methods Forty-five consecutive patients underwent radical cystectomy and "W" shape ileal neobladder substitution for muscle-invasive bladder cancer were recruited.Follow-up and urodynamic evaluation were performed at 12 and 36 months after surgery.Cystourethrography,ultrasonography,IVU and renal function test were performed during the follow-up.Results Of the 45 patients,3 were dead during the follow-up because of cancer-related causes.When comparing to the 12-and 36-month urodynamic parameters,Qmax,MCC,compliance,end-filling pressure,peak flow pressure and PVR respectively were 15.6 ± 2.3 ml/s and 14.9 ± 1.9 ml/s,588.0 ± 264.6 ml and 561.0 ±197.4 ml,27.6±8.4 ml/cm H2O and 29.5 ±1.7 ml/cm H2O,24.4 ±5.2 cm H2O and 33.0 ±6.8 cmH2O,60.7 ±18.0 cm H2O and 79.9 ±28.2 cm H2O,83.5±24.4 ml and 80.4 ±26.8 ml.At early and late evaluation,daytime continence rate was 90％ and 94％,night continence rate was 48％ and 74％.Conclusions Orthotopic W shape ileal neobladder was proven to maintain an adequate capacity and low pressure during a 36-month period of follow-up.The urodynamic results support this urinary diversion as a valid treatment option for muscle-invasive bladder cancer.