Kulkarni J N, Pramesh C S, Rathi S, Pantvaidya G H
Division of Urologic Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
BJU Int. 2003 Apr;91(6):485-8. doi: 10.1046/j.1464-410x.2003.04131.x.
To assess, in a retrospective study, the long-term results of neobladder reconstruction after radical cystectomy, as this is the standard of care for muscle-invasive bladder cancer.
Data were retrieved for all patients with muscle-invasive transitional cell carcinoma of the bladder treated by radical cystectomy and orthotopic neobladder substitution between 1988 and 1998. All perioperative and long-term complications were recorded. The voiding pattern, frequency of micturition and continence were assessed, and a complete urodynamic profile recorded.
In all, 102 patients underwent radical cystectomy with orthotopic neobladder reconstruction in the study period; their mean (range) follow-up was 73 (36-144) months. Neobladder substitution was with an ileocaecal segment in 35 patients, sigmoid colon in 34 and ileum in 33. Early complications occurred in 32 patients (31%) although open surgical intervention was required in only nine (9%). The death rate after surgery was 3.9%. Late complications occurred in 31 patients (30%) and were primarily caused by uretero-enteric and vesico-urethral strictures (9% each). Most patients had daytime (89%) and night-time (78%) continence. The mean maximum pouch capacity (mL) and pouch pressure at capacity (cmH2O) were 562.5 and 23 (ileocaecal), 542 and 17.8 (sigmoid) and 504 and 19.1 (ileal), respectively; the mean postvoid residual was 29, 44 and 23 mL, respectively. Nine patients with ileocaecal neobladders, and 20 and seven with sigmoid and ileal neobladders, required clean intermittent catheterization. Twenty-four patients had recurrence of disease, of whom 20 died.
Orthotopic neobladder reconstruction requires complex surgery but has an acceptable early and late complication rate in properly selected patients. It provides satisfactory continence without compromising cure rates.
在一项回顾性研究中评估根治性膀胱切除术后新膀胱重建的长期结果，因为这是肌层浸润性膀胱癌的标准治疗方法。
检索1988年至1998年间所有接受根治性膀胱切除术并原位新膀胱替代治疗的肌层浸润性膀胱移行细胞癌患者的数据。记录所有围手术期和长期并发症。评估排尿模式、排尿频率和控尿情况，并记录完整的尿动力学资料。
在研究期间，共有102例患者接受了根治性膀胱切除术并原位新膀胱重建；他们的平均（范围）随访时间为73（36 - 144）个月。35例患者采用回盲肠段进行新膀胱替代，34例采用乙状结肠，33例采用回肠。32例患者（31%）发生早期并发症，不过仅9例（9%）需要进行开放手术干预。术后死亡率为3.9%。31例患者（30%）发生晚期并发症，主要由输尿管肠吻合口和膀胱尿道狭窄引起（各占9%）。大多数患者白天（89%）和夜间（78%）能控尿。平均最大膀胱容量（毫升）和膀胱充盈时压力（厘米水柱）分别为：回盲肠段562.5和23，乙状结肠段542和17.8，回肠段504和19.1；平均残余尿量分别为29、44和23毫升。9例回盲肠新膀胱患者，20例乙状结肠新膀胱患者和7例回肠新膀胱患者需要进行清洁间歇性导尿。24例患者疾病复发，其中20例死亡。
原位新膀胱重建需要复杂的手术，但在经过适当选择的患者中，早期和晚期并发症发生率均可接受。它能提供令人满意的控尿效果，且不影响治愈率。
