Ramon J, Leandri P, Rossignol G, Gautier J R
Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Prog Clin Biol Res. 1992;378:125-32.
Between 1980-1989 a total of 349 patients underwent one-stage radical cystoprostatectomy and an orthotopic bladder substitution. 278 patients underwent the Camey I bladder replacement and in 71 patients a detubularized ileal loop was utilized (Camey II). 75 patients underwent a potency-sparing cystectomy (32 patients of the Camey I and 43 patients of the Camey II groups). All patients were followed at least one year and had continence and potency assessment. Among the patients who underwent the Camey I procedure, 66% achieved daytime continence and 21% night-time continence 6 months after surgery. One year after surgery 86% of patients had normal continence during the day and 47% was continent during the night. 14% of patients had episodes of day-time incontinence one year after surgery. Among the patients who underwent the Camey II bladder replacement 86% achieved day-time continence and 59% night-time continence 6 months after surgery. At one year after surgery 91% was continent during the day, 72% was dry during the night and only 9% had episodes of diurnal incontinence. Potency was achieved in 24 of 32 patients (75%) with the Camey I bladder substitution, and in 34 of the 43 patients (79%) with the Camey II bladder substitution. Our data demonstrate that excellent rates of continence and potency are achievable in the post-cystectomy population. Patients with the Camey II bladder replacement achieve continence earlier than patients with the Camey I bladder substitution. Diurnal continence is slightly better after the Camey II procedure, one year after surgery, but the difference is not statistically significant. Nocturnal continence is significantly better with the Camey II bladder substitution.
1980年至1989年间，共有349例患者接受了一期根治性膀胱前列腺切除术及原位膀胱替代术。278例患者接受了卡米I式膀胱替代术，71例患者采用了去管化回肠袢（卡米II式）。75例患者接受了保留性功能的膀胱切除术（卡米I式组32例，卡米II式组43例）。所有患者均随访至少一年，并进行了控尿和性功能评估。在接受卡米I式手术的患者中，术后6个月时66%的患者实现了白天控尿，21%的患者实现了夜间控尿。术后一年，86%的患者白天控尿正常，47%的患者夜间控尿。术后一年，14%的患者出现白天尿失禁。在接受卡米II式膀胱替代术的患者中，术后6个月时86%的患者实现了白天控尿，59%的患者实现了夜间控尿。术后一年，91%的患者白天控尿，72%的患者夜间无尿，仅有9%的患者出现日间尿失禁。卡米I式膀胱替代术的32例患者中有24例（75%）恢复了性功能，卡米II式膀胱替代术的43例患者中有34例（79%）恢复了性功能。我们的数据表明，膀胱切除术后患者可实现较高的控尿率和性功能恢复率。接受卡米II式膀胱替代术的患者比接受卡米I式膀胱替代术的患者更早实现控尿。术后一年，卡米II式手术后日间控尿略好，但差异无统计学意义。卡米II式膀胱替代术的夜间控尿明显更好。
