Taweemonkongsap Tawatchai, Leewansangtong Sunai, Tantiwong Anupan, Soontrapa Suchai
Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Asian J Surg. 2006 Oct;29(4):251-6. doi: 10.1016/S1015-9584(09)60098-1.
To evaluate the surgical technique and functional outcome of a new application of the chimney modification to the popular Hautmann ileal neobladder. This modification used 3-5 cm chimney tubularized ileal segment for the bilateral ureterointestinal anastomosis.
Between December 2000 and July 2004, 15 patients (14 men, 1 woman) with invasive bladder cancer underwent radical cystectomy and Hautmann neobladder with chimney modification at Siriraj Hospital, Bangkok. Mean age was 61.7 years (range, 43-72 years). Perioperative morbidity, early and late urinary diversion-related complications, other surgical complications, follow-up results of ureterointestinal anastomosis, renal function and metabolic disorders were evaluated. Patients were interviewed about their continence, voiding function and potency.
At a mean follow-up of 29.5 months, two patients had died of cancer progression. Of the 15 patients, nine (60%) had 10 early complications. Eight complications were related to the neobladder and two were not. Three (20%) patients had three late complications. Two complications were neobladder-related and one was not. There was no perioperative mortality. There was no ureteroileal anastomosis stricture in this series. Neobladder-ureteral reflux was demonstrated in eight of 22 ureteral units in 11 patients in whom cystography was performed. All patients had normal upper urinary tract without evidence of urinary obstruction. All 14 men (93% of study sample) had spontaneous urination, normal renal function and no metabolic acidosis. Good and satisfactory continence in the day and night were 93% and 73%, respectively. All male patients experienced impotence postoperatively. Only one sought treatment and was successfully treated with sildenafil. The one woman in this study required intermittent catheterization to empty the neobladder completely. She also had renal insufficiency with serum creatinine of 2.2 mg/dL and hyperchloraemic metabolic acidosis.
New chimney modification in Hautmann ileal neobladder is simple and safe. Complications are acceptable. Follow-up results of renal and voiding functions are satisfactory. This operation can maintain good quality of life for patients with bladder cancer undergoing radical cystectomy.
评估一种新型烟囱式改良术应用于常用的豪特曼回肠新膀胱的手术技术及功能结果。该改良术采用3 - 5厘米的烟囱状管状回肠段进行双侧输尿管肠吻合术。
2000年12月至2004年7月期间，15例浸润性膀胱癌患者（14例男性，1例女性）在曼谷诗里拉吉医院接受了根治性膀胱切除术及采用烟囱式改良术的豪特曼新膀胱手术。平均年龄为61.7岁（范围43 - 72岁）。评估围手术期发病率、早期和晚期尿流改道相关并发症、其他手术并发症、输尿管肠吻合术的随访结果、肾功能及代谢紊乱情况。对患者进行关于控尿、排尿功能及性功能的访谈。
平均随访29.5个月时，2例患者死于癌症进展。15例患者中，9例（60%）出现10例早期并发症。8例并发症与新膀胱相关，2例无关。3例（20%）患者出现3例晚期并发症。2例并发症与新膀胱相关，1例无关。无围手术期死亡。本系列中未出现输尿管回肠吻合口狭窄。在11例行膀胱造影的患者中，22个输尿管单位中的8个出现新膀胱输尿管反流。所有患者上尿路正常，无尿路梗阻证据。14例男性患者（占研究样本的93%）均能自主排尿，肾功能正常，无代谢性酸中毒。白天和夜间控尿良好及满意的比例分别为93%和73%。所有男性患者术后均出现阳痿。仅1例寻求治疗并成功接受西地那非治疗。本研究中的1例女性患者需要间歇性导尿以完全排空新膀胱。她还存在肾功能不全，血清肌酐为2.2毫克/分升，并有高氯性代谢性酸中毒。
豪特曼回肠新膀胱的新型烟囱式改良术简单且安全。并发症可接受。肾脏及排尿功能的随访结果令人满意。该手术可为接受根治性膀胱切除术的膀胱癌患者维持良好的生活质量。
