Lin D W, Santucci R A, Mayo M E, Lange P H, Mitchell M E
Department of Urology, University of Washington, Seattle, Washington, USA.
J Urol. 2000 Aug;164(2):356-9.
Orthotopic neobladders are most commonly formed from colon and/or small bowel segments. However, after excellent results were reported in children, we constructed gastric neobladders in select men who had undergone cystectomy. Although gastric neobladders in adults have been reported to have decreased capacity, to our knowledge neither long-term followup nor urodynamic parameters have been reported in these patients.
Gastric neobladder was performed in 8 patients following cystectomy for malignancy in 7 and undiversion in 1. Average followup was 43 months and all patients underwent urodynamic evaluations an average of 9.1 months after surgery. Patients also completed an incontinence questionnaire. The gastric neobladder group was compared to a similar group of patients who underwent neobladder construction from either small bowel (Kock/Hautmann/Studer) or ileocecal segments (Mainz).
The gastric neobladder group had significantly reduced mean bladder capacity compared to the ileal or ileocecal neobladder group (309 versus 551 cc, respectively, t = 0.001), while compliance was similarly decreased (27 versus 59 cc/cm. H2O, respectively, t = 0.04). Incontinence rates were greater in the gastric neobladder group (63%) compared to the ileal or ileocecal neobladder group (8% to 23%, t = 0.02). Complication rates were comparable. Revision or removal was required in 3 (38%) patients for severe incontinence, intractable dysuria and ureterogastric anastomotic stricture, respectively.
Adult gastric neobladders as currently constructed are associated with poor urodynamic parameters and high incontinence rates. Routine use of gastric neobladders in adults is not recommended. They may be appropriate, especially as composites, in select cases such as renal failure or inadequate bowel length. The reasons for success in some patients and not in others are unknown.
原位新膀胱最常由结肠和/或小肠段构建而成。然而，在儿童中报道了良好的结果后，我们为部分接受膀胱切除术的男性构建了胃新膀胱。尽管有报道称成人胃新膀胱容量会减小，但据我们所知，这些患者既没有长期随访结果，也没有尿动力学参数的相关报道。
8例患者在膀胱切除术后接受了胃新膀胱手术，其中7例因恶性肿瘤行膀胱切除术，1例因膀胱改道术失败行此手术。平均随访时间为43个月，所有患者在术后平均9.1个月接受了尿动力学评估。患者还完成了一份尿失禁问卷。将胃新膀胱组与一组类似的、接受由小肠（Kock/Hautmann/Studer术式）或回盲肠段（Mainz术式）构建新膀胱的患者进行比较。
与回肠或回盲肠新膀胱组相比，胃新膀胱组的平均膀胱容量显著降低（分别为309毫升和551毫升，t = 0.001），顺应性同样降低（分别为27毫升/厘米水柱和59毫升/厘米水柱，t = 0.04）。胃新膀胱组的尿失禁发生率高于回肠或回盲肠新膀胱组（63% 对比8%至23%，t = 0.02）。并发症发生率相当。3例（38%）患者分别因严重尿失禁、顽固性排尿困难和输尿管-胃吻合口狭窄需要进行修复或切除手术。
目前构建的成人胃新膀胱与不良的尿动力学参数和高尿失禁发生率相关。不建议在成人中常规使用胃新膀胱。在某些特定情况下，如肾衰竭或肠段长度不足时，胃新膀胱可能是合适的，尤其是作为复合结构。部分患者成功而部分患者未成功的原因尚不清楚。
