Sohag University Hospital, Sohag, Egypt.
Urol Oncol. 2011 Jul-Aug;29(4):366-71. doi: 10.1016/j.urolonc.2010.03.014. Epub 2010 Jun 17.
We report on the feasibility and outcomes of the N-shaped pouch with an afferent tubular isoperistaltic segment as a new technique for creating a capacious, low pressure bladder substitute following radical cystectomy.
Between April 2000 and April 2006, 42 patients (36 male, 6 female) with invasive bladder cancer were considered good candidates for orthotopic urinary diversion. All had radical cystectomy with bilateral pelvic lymphadenectomy and orthotopic bladder substitution by an ileal low pressure reservoir (N-shaped) with an afferent isoperistaltic tubular segment. Of the 42 patients, 36 (86%) had squamous cell carcinoma; 6 had transitional cell carcinoma. None of the patients had positive lymph nodes after pathologic examination of the specimen. The patients were available for a median follow-up period of 24.8 months. Follow-up included clinical and radiographic studies to determine functional and oncological outcomes.
Eleven patients (26.2%) had early complications during the period ≤ 3 months following surgery. Seven of these patients had complications such as wound infection, prolonged ileus, persistent urinary leakage, and deep venous thrombosis that were treated conservatively. One female patient developed a pouch-vaginal fistula that required repair. The remaining 3 patients had oncologic failures, 1 of which was isolated urethral recurrence. Late complications occurred in 15 patients (35.7%). These included pouch stones, outflow obstruction, mucus retention, and adhesive bowel obstruction. Daytime and night-time continence was achieved in 92% and 80% of the patients, respectively, and ureteroileal stricture was observed in 5%. The upper tracts remained unchanged or improved in nearly 95% of the patients.
Ileal orthotopic bladder substitution (N-shaped) with an afferent ileal tubular segment offers good functional results with good preservation of the renal units. It is considered a safe and technically feasible surgical procedure.
我们报告一种新的技术，即 N 形袋加输入段具有蠕动功能的管状吻合，作为根治性膀胱切除术后创建一个具有大容量和低压力的膀胱替代物的可行性和结果。
2000 年 4 月至 2006 年 4 月，42 例浸润性膀胱癌患者被认为是适合进行原位尿流改道的良好候选者。所有患者均接受根治性膀胱切除术，双侧盆腔淋巴结清扫术，并采用带有输入段具有蠕动功能的管状吻合的回肠低压储尿囊（N 形）进行原位膀胱替代。42 例患者中，36 例（86％）为鳞状细胞癌；6 例为移行细胞癌。术后标本的病理检查均无阳性淋巴结。患者中位随访时间为 24.8 个月。随访包括临床和影像学研究，以确定功能和肿瘤学结果。
11 例（26.2％）患者在术后 3 个月内出现早期并发症。其中 7 例患者出现并发症，如伤口感染、肠梗阻延长、持续性尿漏和深静脉血栓形成，均采用保守治疗。1 例女性患者发生了 pouch-vaginal 瘘，需要修复。其余 3 例患者发生了肿瘤学失败，其中 1 例为孤立性尿道复发。15 例（35.7％）患者发生晚期并发症。这些并发症包括储袋结石、流出道梗阻、黏液潴留和粘连性肠梗阻。92％和 80％的患者分别实现了日间和夜间的控尿，5％的患者发生了输尿管-回肠吻合口狭窄。近 95％的患者上尿路保持不变或改善。
回肠原位膀胱替代（N 形）加输入段具有蠕动功能的管状吻合可获得良好的功能结果，同时很好地保留了肾单位。它被认为是一种安全且技术可行的手术。
