Department of Urology, The First People's Hospital of Huzhou, Affiliated Hospital of Huzhou Teachers' College, Huzhou, P.R. China.
Urol Oncol. 2013 Nov;31(8):1599-605. doi: 10.1016/j.urolonc.2012.02.010. Epub 2012 Apr 4.
The objectives of this study are to introduce the surgical technique of a modified spiral orthotopic ileal neobladder and to assess the long-term outcomes.
Between January 1998 and January 2006, 44 male and 7 female patients with bladder cancer received radical cystectomy (RC) and pelvic lymphadenectomy. An ileal segment 40 cm to 45 cm long was isolated to create a spiral orthotopic ileal neobladder, and the ureters were implanted into the reservoir using a non-refluxing split-cuff nipple technique. Preoperative, perioperative, and postoperative data were collected. Complications were classified as early (less than 3 months after surgery) or late (more than 3 months after surgery). Continence incidence and urodynamic studies were evaluated 5 years after surgery. Duration of follow-up was an average of 95 months (range 60-156 months).
There were no perioperative deaths. The mean operative time was 315 ± 34 minutes. The mean blood loss was 783 ± 316 ml. There were 31 early complications in 21 patients (41%) and 42 late complications in 30 patients (59%). Urodynamic studies showed the maximum neobladder capacity to be 500 ± 71 ml, maximum flow rate to be 16 ± 5 ml/s and post-voiding residual (PVR) to be 50 ± 44 ml. Postoperative continence was excellent with a daytime continence rate of 90% and a nocturnal continence rate of 78% 5 years after surgery.
The modified spiral neobladder is easy to perform and allows for excellent long-term results with regard to complications and continence.
本研究旨在介绍改良螺旋原位回肠新膀胱术的手术技术，并评估其长期疗效。
1998 年 1 月至 2006 年 1 月，44 名男性和 7 名女性膀胱癌患者接受根治性膀胱切除术（RC）和盆腔淋巴结清扫术。游离一段 40-45cm 长的回肠段，构建螺旋原位回肠新膀胱，采用非反流式分裂袖套乳头技术将输尿管植入储尿囊。收集术前、围手术期和术后数据。并发症分为早期（术后 3 个月内）和晚期（术后 3 个月后）。术后 5 年评估控尿率和尿动力学研究。随访时间平均为 95 个月（60-156 个月）。
无围手术期死亡。手术时间平均为 315±34 分钟，术中出血量平均为 783±316ml。21 例患者（41%）发生 31 例早期并发症，30 例患者（59%）发生 42 例晚期并发症。尿动力学研究显示，新膀胱最大容量为 500±71ml，最大尿流率为 16±5ml/s，残余尿量（PVR）为 50±44ml。术后 5 年，日间控尿率为 90%，夜间控尿率为 78%，控尿效果良好。
改良螺旋新膀胱术操作简单，在并发症和控尿方面具有良好的长期效果。
