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目的:回顾分析行回肠新膀胱术治疗膀胱移行细胞癌的手术体会及长期随访结果。方法:从1988年1月至2006年12月,共有61例膀胱移行细胞癌患者行根治性膀胱切除+回肠新膀胱术。回肠新膀胱术采用回肠末端肠段,作对系膜缘切开,然后将回肠片U形排列缝合,间断内翻缝合重建膀胱颈,输尿管行黏膜沟再植。对患者的围手术期死亡率、并发症、尿控情况、肾功能、影像学及尿动力学检查结果进行评估。结果:除1例围术期死亡外,其余患者随访12~168个月。共死亡13例。并发症为肾功能不全11例、输尿管新膀胱吻合口狭窄9例、膀胱输尿管反流6例、尿漏5例、出血4例、切口疝4例、尿道狭窄3例、尿道复发1例。42例患者尿控效果满意。结论:经过长期随访,我们提出的新型原位回肠膀胱术是一种效果良好、并发症较低的尿道改道术,有一定的临床应用价值。
OBJECTIVE: To retrospectively analyze the surgical experience and long-term follow-up of bladder ileal neo-bladder surgery for bladder transitional cell carcinoma. Methods: From January 1988 to December 2006, a total of 61 patients with bladder transitional cell carcinoma underwent radical cystectomy and ileal neo-bladder surgery. Ileal neo-bladder surgery using the distal ileum bowel segment, for mesangial margin incision, and then the ileum U-shaped arrangement of sutures, intermittent inversion suture reconstruction of the bladder neck, ureter line mucosal groove replantation. Perioperative mortality, complications, urinary control, renal function, imaging and urodynamic findings were evaluated. Results: All cases were followed up for 12 ~ 168 months except 1 perioperative death. A total of 13 deaths. Complications were renal insufficiency in 11 cases, ureteral neovagina anastomosis stenosis in 9 cases, vesicoureteral reflux in 6 cases, urinary leakage in 5 cases, hemorrhage in 4 cases, incisional hernia in 4 cases, urethral stricture in 3 and urethral recurrence in 1 case. 42 patients with satisfactory results of urine control. Conclusion: After long-term follow-up, we propose a new type of ileal bladder surgery with good effect and low complication of urethral diversion, which has certain clinical value.