Alcini E, D'Addessi A, Racioppi M, Menchinelli P, Anastasio G, Grassetti F, Destito A, Giustacchini M
Department of Surgery, Università Cattolica del S. Cuore, Rome, Italy.
J Urol. 1993 Apr;149(4):735-8. doi: 10.1016/s0022-5347(17)36195-5.
Since 1987, 30 patients with bladder cancer underwent cystoprostatectomy with bladder replacement via ileocecourethrostomy. Multiple transverse teniamyotomies were made in the cecum to assure a large capacity reservoir with low pressures. The particular anatomy and physiology of the cecum, short length of the intestinal segment needed and teniamyotomies are the 3 factors that have allowed for good functional and metabolic results. All patients achieved daytime continence. After 3 years of followup 67% of the patients were continent at night if they voided every 3 or 4 hours and 22% if they voided every 2 or 3 hours, while 11% experienced enuresis. Urodynamic data after 1 year showed a mean capacity of 396 ml. for the new bladder, a mean full filling pressure of 28 cm. water and a mean maximum pressure of 55 cm. water. Post-micturition residual urine volume was consistently less than 55 ml. These results indicate that the ileocecal segment can be enlarged with myotomies through the tenia to produce an adequate capacity and a low pressure bladder replacement without the need for formal detubularization.
自1987年以来，30例膀胱癌患者接受了经回盲部尿道吻合术的膀胱前列腺切除术及膀胱替代术。在盲肠进行多处横行肠肌切开术，以确保形成一个大容量、低压的储尿囊。盲肠独特的解剖结构和生理特性、所需肠段较短以及肠肌切开术是取得良好功能和代谢结果的三个因素。所有患者白天均能保持控尿。经过3年的随访，如果每3或4小时排尿一次，67%的患者夜间能保持控尿；如果每2或3小时排尿一次，22%的患者夜间能保持控尿，而11%的患者有遗尿现象。1年后的尿动力学数据显示，新膀胱的平均容量为396毫升，平均充盈压为28厘米水柱，平均最大压力为55厘米水柱。排尿后残余尿量始终小于55毫升。这些结果表明，通过沿结肠带进行肌切开术可扩大回盲部肠段，从而形成一个容量足够且低压的膀胱替代物，而无需进行正规的去管化操作。
