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目的:评价利用肛门括约肌控尿的乙状结肠新膀胱术在治疗男性膀胱癌中的临床效果。方法:回顾性分析1999年6月至2008年3月16例男性膀胱全切、利用肛门括约肌控尿的乙状结肠新膀胱尿流改道患者资料。患者年龄48～83岁,平均61岁。均为膀胱移行细胞癌,T2N0M014例,T3N1M02例。术中利用远端乙状结肠20cm,去管化重建成近似球形的新膀胱,双输尿管与新膀胱抗返流吻合,并恢复肠道的连续性。结果:手术时间3～4h,平均3.5h。输血量200～600mL,平均400mL。无术中和术后早期并发症。术后3个月膀胱容量350～550mL,平均460mL,无残余尿及尿失禁。术后6个月尿流动力学检查4例,患者最大尿流率19.4～78.4mL/s,平均38.1mL/s,最大排尿压23.6～63.4cmH2O,平均45.0cmH2O。1例出现盆腔转移,1例偶有发热,无尿道肿瘤复发,肾功能和电解质正常。结论:利用肛门括约肌控尿的乙状结肠新膀胱术并发症少,排尿和控尿功能满意,是一种安全、有效的尿流改道方法。
Objective: To evaluate the clinical effect of sigmoid colon neo-bladder surgery with anal sphincter in the treatment of male bladder cancer. Methods: A retrospective analysis of 16 cases of male bladder resection from June 1999 to March 2008 was conducted. The data of patients with sigmoid colon neo-bladder urinary diversion using anal sphincter was analyzed retrospectively. Patients aged 48 to 83 years, mean 61 years. All of bladder transitional cell carcinoma, T2N0M014 cases, T3N1M02 cases. Intraoperative use of the distal sigmoid colon 20cm, to tube to reconstruct a nearly spherical new bladder, double ureter and neo-bladder anti-reflux anastomosis, and restore the continuity of the intestine. Results: The operation time was 3 ~ 4 hours with an average of 3.5 hours. Blood transfusion 200 ~ 600mL, an average of 400mL. No intraoperative and postoperative early complications. Three months after surgery bladder capacity 350 ~ 550mL, an average of 460mL, no residual urine and urinary incontinence. In the 6 months after operation, 4 patients had urodynamics, the maximal uroflow rate was 19.4-78.4 mL / s, with an average of 38.1 mL / s and the maximum urinary pressure was 23.6-63.4 cmH2O with an average of 45.0 cmH2O. One case had pelvic metastases, one case had occasional fever, no recurrence of urethral tumors, and normal renal function and electrolytes. CONCLUSIONS: The sigmoid colon neo-bladder with anal sphincter control is less invasive and has satisfactory voiding and urinary control functions. It is a safe and effective method of urinary diversion.