Rogers E, Scardino P T
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.
J Urol. 1995 May;153(5):1432-8. doi: 10.1016/s0022-5347(01)67422-6.
Bladder substitution using pouches designed from detubularized bowel is gaining widespread acceptance among urologists and their patients. However, few clinical reports have described the effectiveness of the orthotopic neobladder fashioned from ileum in the manner described by Studer. Since 1988, we have used the Studer technique with minor modifications in 20 men who underwent radical cystoprostatectomy for transitional cell carcinoma of the bladder. Early morbidity from the procedure was minimal, although 2 patients later had anastomotic strictures. Significant late complications included low vitamin B12 levels in 4 patients and persistent hyperchloremia in 1. A total of 18 patients achieved diurnal continence but 9 of these had enuresis. Neobladder compliance and emptying were satisfactory in the 12 patients evaluated urodynamically. Upper tracts remained stable in all patients at a median followup of 24 months (range 9 to 60). Isolated episodes of bacteriuria occurred in 11 patients but followup urine cultures have remained sterile in all continent patients. The Studer ileal neobladder is a simple, effective alternative for urine storage, upper tract preservation and efficient voiding.
使用去管状化肠段设计的肠袋进行膀胱替代术在泌尿外科医生及其患者中越来越被广泛接受。然而，很少有临床报告描述按照施图德（Studer）所描述的方式用回肠制作的原位新膀胱的有效性。自1988年以来，我们对20例因膀胱移行细胞癌接受根治性膀胱前列腺切除术的男性患者采用了略加修改的施图德技术。尽管有2例患者后来出现吻合口狭窄，但该手术的早期发病率极低。显著的晚期并发症包括4例患者维生素B12水平低和1例患者持续性高氯血症。共有18例患者实现日间控尿，但其中9例有遗尿。在接受尿动力学评估的12例患者中，新膀胱顺应性和排空情况令人满意。在中位随访24个月（范围9至60个月）时，所有患者的上尿路均保持稳定。11例患者出现孤立性菌尿发作，但所有控尿患者的后续尿培养均保持无菌。施图德回肠新膀胱是一种用于尿液储存、上尿路保留和有效排尿的简单、有效的替代方法。
