摘要目的 探讨回肠原位新膀胱术中输尿管与储尿囊抗反流技术的临床应用价值.方法 2009年1月至2014年1月对27例根治性膀胱切除术患者行抗反流原位回肠新膀胱术.男23例,女4例.年龄41～77岁,平均61岁.27例均经膀胱镜活检确诊为膀胱尿路上皮细胞癌.临床分期:T1～ T2N0M019例,T3N0M08例.均在全麻下行根治性膀胱切除术+带回肠输入段的抗反流新膀胱术.术中按标准方法行根治性膀胱切除术后,取回肠约48 cm构建新膀胱,其中10～12 cm为输入段,储尿囊与回肠输入段交界处2～3 cm缝合形成抗反流的回肠壁瓣膜.将双侧输尿管直接拖入回肠输入段内约1 cm,输尿管与回肠浆肌层双排缝合固定吻合.结果 本组27例手术均顺利完成.手术时间300 ～ 450 min,平均320 min.术中出血量250～1 200 ml,平均400 ml.抗反流回肠壁瓣膜成形+储尿囊构建时间35 ～ 50 min,平均41 min.术中无并发症发生.术后随访3～44个月,平均21个月,无膀胱输尿管反流和吻合口狭窄病例.术后3、6、12、24个月患者日间完全控尿率分别为66.7％ (18/27)、75.0％ (18/24)、95.7％(22/23)、100.0％ (16/16);夜间完全控尿率分别为59.3％(16/27)、70.8％ (17/24)、86.9％(20/23)、93.8％(15/16).22例术后6、12个月行尿动力学检查,最大新膀胱容量分别为360、430 ml;最高充盈膀胱压分别为17、14 cmH2O(1 cmH2O=0.098 kPa).结论 抗反流回肠壁瓣膜成形联合输尿管拖入吻合技术构建的原位新膀胱具有较好的功能效果,术中操作简易、快速、可靠,术后无输尿管反流和膀胱吻合口狭窄.

abstractsObjective To evaluate the clinical value of the orthotopic ileal neobadder with the ileum valvuloplasty and pulling antireflux technique for ureteroileal anastomosis.Methods The data of 27 cases underwent orthotopic ileal neobadder of which all cases with multiple or invasive carcinoma of bladder.There were 23 males and 4 females with an average of 61 (41-77) yrs accepted antireflux ileal neobladder with an afferent tubular segment after the radical cystectomy from Jan.2009 to Jan.2014.The clinic stage in these patients included in 19 T1-2N0M0 cases and 8 T3N0M0 cases.In our technique,we retrieved the intestinal about 48 cm for the construction of neobadder,with 10-12 cm used as input segment,and pouch input section of ileum junction 2-3 cm sutured to form ileum valve anti reflux;pulling the ureter inside of the afferent tubular ileal segment,with two rows sutures fixing the seromuscular layer of the ureter to the seromuscular layer of the ileal segment.The following parameters were considered:operative time,complications and functional outcomes.Results The mean operative time,and intraoperative blood loss were 320 (300-450) min and 400 (250-1 200) ml,respectively.The operative time for neobladder reconstruction was 41 (35 to 50) min.Follow-up was 21 (3 to 44) mon.No sever complications or stricture of the ureteral-neobladder anastomisis were recorded.The day time continence rates at 3,6,12 and 24 months postoperatively daytime were 66.7％,75.0％,95.7％ and 100.0％,nighttime 59.3％,70.8％,86.9％ and 93.8％,respectively.Urodynamic studies were performed in 22 patients,6 months and one year after surgery,the average maximal neigladder capacity was 360 ml and 430 ml,the average pressure at maximal capacity was 17 cmH2O and 14 cmH2O.Conclusions The antireflux ileal neobladder with an afferent tubular segment have good functional outcomes.Technique for ureteroileal anastomosis in orthotopic ileal neobladder avoids stenosis.It is easy,rapid and reliable procedure.