Fujisawa Masato, Takenaka Atsushi, Kamidono Sadao
Department of Urology, Kawasaki Medical School, Kurashiki, Japan.
Urology. 2003 Aug;62(2):254-8. doi: 10.1016/s0090-4295(03)00267-x.
To present the results of a new technique for construction of a sigmoid neobladder after radical cystectomy.
Forty-two men, 43 to 74 years of age (mean age 62 +/- 8), underwent radical cystectomy for invasive bladder cancer and had a sigmoid neobladder created using a modification of the standard ureterointestinal anastomosis with rotation of the reservoir. The mean follow-up of this retrospective study was 35 +/- 20 months (range 6 to 90). The blood chemistry was analyzed routinely during follow-up, and complications, continence, and voiding pattern were assessed at regular intervals.
There were 21 early complications in 14 patients: persistent urinary leakage in 2; wound infection in 9; prolonged ileus in 4; leakage from the colonic anastomosis in 2; and pulmonary embolus in 2. One patient each had venous thrombus of the lower extremities and methicillin-resistant Staphylococcus aureus colitis. One patient died in the perioperative period of massive pulmonary embolus, yielding a mortality rate of 2.4%. Eleven late complications occurred in 9 patients. Stenosis of the ureterointestinal anastomosis developed in 2 of 82 anastomoses, stenosis of urethral anastomosis in 4, and neobladder-ureteral reflux in 1. A reservoir stone was found in 1 patient, and adenoma and adenocarcinoma of the reservoir occurred in 1 patient each. One patient developed symptomatic hyperchloremic metabolic acidosis, and routine electrolyte evaluation revealed a slight metabolic acidosis in 6 patients. Hypovitaminosis B(12) did not occur in any patients. Of the 42 patients, 40 could void volitionally without catheterization. Patient satisfaction on continence, by day and night, was 77.3% and 72.7%, respectively. The mean neobladder capacity and the mean residual urine volume was 375 +/- 116 mL (range 234 to 624) and 68 +/- 86 mL (range 4 to 365), respectively.
The modified sigmoid neobladder provides satisfactory results after radical cystectomy.
介绍一种根治性膀胱切除术后乙状结肠新膀胱构建新技术的结果。
42例年龄在43至74岁（平均年龄62±8岁）的男性因浸润性膀胱癌接受了根治性膀胱切除术，并采用改良的标准输尿管肠吻合术并旋转储尿囊构建乙状结肠新膀胱。这项回顾性研究的平均随访时间为35±20个月（范围6至90个月）。随访期间定期分析血液化学指标，并定期评估并发症、控尿情况和排尿模式。
14例患者出现21例早期并发症：2例持续性尿漏；9例伤口感染；4例肠梗阻持续时间延长；2例结肠吻合口漏；2例肺栓塞。各有1例患者发生下肢静脉血栓和耐甲氧西林金黄色葡萄球菌结肠炎。1例患者在围手术期死于大面积肺栓塞，死亡率为2.4%。9例患者出现11例晚期并发症。82例吻合口中有2例发生输尿管肠吻合口狭窄，4例发生尿道吻合口狭窄，1例发生新膀胱输尿管反流。1例患者发现储尿囊结石，各有1例患者发生储尿囊腺瘤和腺癌。1例患者出现有症状的高氯性代谢性酸中毒，常规电解质评估显示6例患者有轻度代谢性酸中毒。所有患者均未发生维生素B12缺乏症。42例患者中，40例可自主排尿无需导尿。患者白天和夜间控尿的满意度分别为77.3%和72.7%。新膀胱平均容量和平均残余尿量分别为375±116 mL（范围234至624）和68±86 mL（范围4至365）。
改良乙状结肠新膀胱在根治性膀胱切除术后可提供满意的结果。
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