目的总结改良全膀胱切除原位新膀胱术治疗浸润性膀胱癌的临床经验。方法采用改良全膀胱切除原位新膀胱术治疗局部浸润性膀胱癌患者96例,患者均为男性,平均年龄55岁。96例中移行细胞癌91例,WHO分级Ⅲ级39例、Ⅱ级51例、Ⅰ级1例;鳞癌3例;腺癌2例。肿瘤多发92例(移行细胞癌91例、腺癌1例),单发4例(鳞癌3例、腺癌1例)。TNM临床分期T2N0M0 88例,T3N0M06例,T3N1M0 2例。统计手术时间、术中出血和输血量,对新膀胱功能、并发症、肿瘤控制和患者生存情况进行随访分析。结果96例患者无手术死亡,手术时间190—330min,平均260 min。术中出血150～1200 ml,输血30例。病理分期T1N0M0 1例,T2N0M0 89例,T3aN0M0、T3aN1M0和L3bN1M0各2例。随访5～58个月,平均31个月。无瘤生存94例,因肿瘤死亡2例。新膀胱白天控尿良好93例(97％),夜间控尿良好80例(83%)。剩余尿量0—80 ml者87例,100～250 ml者7例。主要并发症:切口裂开3例,二次缝合治愈;输尿管吻合口漏1例,再吻合后治愈;输尿管口狭窄2侧和输尿管口粘连4侧,经内镜下手术纠正;严重肠梗阻3例和慢性酸中毒低钾2例均经内科处理纠正。无严重远期并发症。结论改良全膀胱切除原位新膀胱术后肿瘤控制满意,严重并发症少,新膀胱控尿良好,患者生活质量高,是目前治疗浸润性膀胱癌的理想方法之一。 Objective To summarize the clinical experience of modified total cystectomy in situ neobladder for the treatment of invasive bladder cancer. Methods Ninety-six patients with locally invasive bladder cancer were treated with modified total cystectomy in situ neobladder. The patients were all male, with an average age of 55 years. Among the 96 cases, there were 91 cases of transitional cell carcinoma, 39 cases of WHO grade Ⅲ, 51 cases of grade Ⅱ, 1 case of grade Ⅰ, 3 cases of squamous cell carcinoma and 2 cases of adenocarcinoma. Tumor 92 cases (transitional cell carcinoma in 91 cases, adenocarcinoma in 1 case), single in 4 cases (3 cases of squamous cell carcinoma, adenocarcinoma in 1 case). TNM clinical stage T2N0M0 88 cases, T3N0M06 cases, T3N1M0 2 cases. Statistical operation time, intraoperative bleeding and blood transfusion, follow-up analysis of new bladder function, complications, tumor control and patient survival. Results 96 patients died without surgery, the operation time was 190-330min, with an average of 260 min. Intraoperative bleeding 150 ~ 1200 ml, 30 cases of blood transfusion. Pathological staging T1N0M0 1 cases, T2N0M0 89 cases, T3aN0M0, T3aN1M0 and L3bN1M0 2 cases each. Followed up for 5 to 58 months, an average of 31 months. 94 cases of tumor-free survival, 2 cases of tumor death. Neo-bladder control during the day was good in 93 cases (97%), and good in 80 cases (83%) at night. 87 cases of remaining urine volume 0-80 ml, 7 cases of 100 ~ 250 ml. Main complications: incision in 3 cases, secondary suture cure; ureteral anastomotic leakage in 1 case, and then cured after anastomosis; ureteral stenosis on the 2 side and ureter mouth adhesion 4 sides, corrected by endoscopic surgery; severe intestinal obstruction 3 Cases and chronic acidosis, hypokalemia in 2 cases were corrected by internal medicine. No serious long-term complications. Conclusions The improved total cystectomy is an ideal method for the treatment of invasive bladder cancer with satisfactory tumor control, less serious complications, good urinary bladder control, and high quality of life.