Lim S T, Wong K K, Li M K
Ann Acad Med Singap. 1984 Oct;13(4):651-7.
In patients with advanced carcinoma of the bladder not involving the trigone, radical total cystectomy with bladder replacement (replacement cystoplasty) using either the colon, ileum or stomach can be performed. In male patients, the prostatic urethra is always included in the resection so that the extent of radical surgery is not compromised. Thus the neobladder is anastomosed to the membranous urethra in these patients. In patients with contracted tuberculous bladder, the neobladder is anastomosed to the trigone after subtotal cystectomy (augmentation cystoplasty). The pattern of micturition is studied in 32 patients with cystoplasty after cystectomy. Emptying of the neobladder is achieved and completed mainly by abdominal straining rather than by the spontaneous contraction of the gastrointestinal segment, as evidenced by cystometric studies. The stomach generates high pressures during its peristaltic contractions but this could be a disadvantage during the early postoperative period particularly in the females, as urinary incontinence may result. In the majority of patients, micturition takes place every 2 to 3 hours with full urinary continence during the waking hours. However, in patients after radical total cystectomy, incontinence of urine during deep sleep is inevitable. No differences of voiding pattern, bladder capacity and residual urine volume are noted when either the colon, ileum or stomach is used for cystoplasty.
对于晚期膀胱癌且未累及三角区的患者，可采用结肠、回肠或胃进行根治性全膀胱切除术并膀胱替代（替代膀胱成形术）。在男性患者中，前列腺尿道总是包含在切除范围内，这样根治性手术的范围就不会受到影响。因此，在这些患者中，新膀胱与膜部尿道吻合。对于结核性膀胱挛缩患者，在膀胱部分切除术后（扩大膀胱成形术），新膀胱与三角区吻合。对32例膀胱切除术后行膀胱成形术的患者的排尿模式进行了研究。膀胱测压研究表明，新膀胱的排空主要通过腹部用力而不是胃肠道段的自发收缩来实现和完成。胃在蠕动收缩时会产生高压，但这在术后早期可能是一个不利因素，尤其是在女性患者中，因为可能会导致尿失禁。在大多数患者中，排尿每2至3小时进行一次，清醒时完全控尿。然而，在根治性全膀胱切除术后的患者中，深度睡眠时尿失禁是不可避免的。当使用结肠、回肠或胃进行膀胱成形术时，排尿模式、膀胱容量和残余尿量没有差异。
