Miller K, Steiner U, Hautmann R
Departamento de Urología, Universidad de Ulm, Alemania.
Arch Esp Urol. 1992 Nov;45(9):897-902.
Since April 1986, 227 patients received an ileal neobladder at our institution. Of these patients 206 underwent simultaneous radical cystectomy for bladder cancer, and 21 received a bladder augmentation. The mean postoperative follow-up ranges from 3-71 months. Perioperative mortality was 2.55 percent, 15 percent of the patients died later than 2 months postoperatively, 13.4 percent due to tumor progression, 1.5 percent because of pneumonia, severe metabolic acidosis, myocardial infarction and apoplexia. Day and night continence was preserved in 77 percent of the patients with a follow-up of more than 2 years; severe stress incontinence was found in 2 patients, and night time incontinence needing some external device in 4.6 percent. 11.5 percent with mild stress incontinence do not require further treatment. Our experience with this relatively simple procedure is excellent: the need for re-operation is low and the high reservoir capacity results in early continence in most cases. This concept offers a genuine alternative to any form of cutaneous urinary diversion with an incidence of complications not higher than after standard supravesical urinary diversion.
自1986年4月以来，我院有227例患者接受了回肠新膀胱术。其中206例因膀胱癌同期接受了根治性膀胱切除术，21例接受了膀胱扩大术。术后平均随访时间为3至71个月。围手术期死亡率为2.55%，15%的患者在术后2个月后死亡，其中13.4%死于肿瘤进展，1.5%死于肺炎、严重代谢性酸中毒、心肌梗死和中风。随访超过2年的患者中，77%实现了昼夜控尿；2例出现严重压力性尿失禁，4.6%的患者夜间尿失禁需要借助一些外部装置。11.5%的患者有轻度压力性尿失禁，无需进一步治疗。我们在这个相对简单的手术方面的经验非常好：再次手术的需求较低，而且储尿囊容量大，多数情况下能早期实现控尿。这一理念为任何形式的皮肤造口尿流改道术提供了一个真正的替代方案，其并发症发生率不高于标准的膀胱上尿流改道术。
