Gutiérrez Baños J L, Martín García B, Hernández Rodríguez R, Portillo Martín J A, Correas Gómez M A, del Valle Schaan J I, Monge Mirallas J M, Roca Edreira A
Servico de Urología, Hospital Universitario Valdecilla, Santander, Cantabria, España.
Arch Esp Urol. 1995 Oct;48(8):783-90.
The results of the Studer enterocystoplasty technique is analyzed, with special reference to the early and late complications and urinary continence.
We reviewed the records of 20 patients that underwent bladder substitution according to the Studer technique due to bladder carcinoma from 1990-1993. Patient follow-up ranged from 6-36 months. The ureteroileal anastomosis was done by the single stitch technique onto a tubularized ileal chimney.
The median age was 57.2 +/- 11.86 yrs (range 33-73). The preoperative stay for intestinal preparation ranged from 1-29 days (median 4.4 +/- 5.84) and the postoperative stay ranged from 1-60 days (median 26 +/- 11.44). The average operating time was 5.30 +/- 0.7 hours (range 4.15-7). There were two postoperative deaths; one from acute myocardial infarction and the other from pulmonary embolism. Three patients died from tumor progression during follow-up and one from leg ischemia 17 months postoperatively. Early complications: 2 cases of prolonged ileus, 1 wound infection, 7 urinary infections, 1 low debit intestinal fistula which resolved with parenteral nutrition, 3 patients had leakage at the ileourethral anastomosis which resolved with prolonged catheter drainage of 3-15 days, 1 hemorrhage from acute lesions to the gastric mucosa, 3 fascial dehiscence and 1 ureteroileal fistula that required reimplantation into the neobladder. Late complications: 1 ureteroileal stenosis that progressed to renal atrophy, 1 enterourethral stenosis that resolved with internal urethrotomy and 2 cases of severe metabolic acidosis and dehydration that resolved with fluid therapy. No differences were observed between the creatinine, pH and ion levels preoperatively and during follow-up. Continence was assessed in 17 cases: 100% were continent during the day, 41.2% were continent during the night, 4 had occasional nocturnal leakage and 6 required collecting devices during the night.
The Studer technique provides good results and quality of life to patients undergoing cystectomy. Although it carries a high morbidity, conservative management will suffice in a high percentage of cases.
分析Studer回肠膀胱扩大术的结果，特别关注早期和晚期并发症以及尿失禁情况。
我们回顾了1990年至1993年间因膀胱癌根据Studer技术接受膀胱替代术的20例患者的记录。患者随访时间为6至36个月。输尿管回肠吻合术采用单针技术在管状回肠烟囱上进行。
中位年龄为57.2±11.86岁（范围33 - 73岁）。术前肠道准备住院时间为1至29天（中位值4.4±5.84），术后住院时间为1至60天（中位值26±11.44）。平均手术时间为5.30±0.7小时（范围4.15 - 7小时）。术后有2例死亡；1例死于急性心肌梗死，另1例死于肺栓塞。3例患者在随访期间死于肿瘤进展，1例在术后17个月死于腿部缺血。早期并发症：2例肠梗阻延长，1例伤口感染，7例泌尿系统感染，1例低流量肠瘘经肠外营养治愈，3例患者回肠尿道吻合口漏经3至15天延长导尿治愈，1例急性胃黏膜病变出血，3例筋膜裂开，1例输尿管回肠瘘需重新植入新膀胱。晚期并发症：1例输尿管回肠狭窄进展为肾萎缩，1例尿道狭窄经尿道内切开治愈，2例严重代谢性酸中毒和脱水经液体治疗治愈。术前和随访期间肌酐、pH值和离子水平无差异。对17例患者进行了尿失禁评估：100%白天能控制排尿，41.2%夜间能控制排尿，4例偶尔夜间漏尿，6例夜间需要收集装置。
Studer技术为接受膀胱切除术的患者提供了良好的效果和生活质量。虽然其发病率较高，但在大多数情况下保守治疗就足够了。
