Regalado Pareja R, Huguet Pérez J, Errando Smet C, Lima B X, Chéchile Toniolo G, Villavicencio Mavrich H
Servicio de Urología, Fundación Puigvert, Barcelona, España.
Arch Esp Urol. 1997 Apr;50(3):234-41.
Since 1988, 100 Studer ileal low pressure urinary reservoirs have been performed at our institution. The functional results and the complications observed in these patients are presented.
Patients submitted to radical cystectomy and lower urinary tract reconstruction with the Studer technique from 1988 to 1994 were retrospectively studied. All patients were males, their mean age was 60 years (37-75) and the mean follow-up was 18 months (6-72). The isoperistaltic ileal segment as antireflux mechanism was utilized in 97 cases and intussusception of the ileal segment to which the ureters were anastomosed in 3 cases. Reinsertion of the ureter was done using the Wallace technique in 90 cases and by direct fixation according to a personal technique (H.V.) in 10 cases. Anastomosis of the neobladder and the urethra was done with the end of the second suture of the orthotopic reservoir. The neurovascular bands were preserved in 21 patients less than 60 years old with tumor stage T2-T3a, according to the technique described by Walsh and Mostwin (1984).
One patient died early postoperatively from sepsis. The early complications included urinoma (4%), urinary fistula (3%), intestinal fistula (2%), pulmonary complications (4%), pelvic hematoma (1%) and intestinal obstruction (3%). Only 4 of these patients required surgical resolution of the complication. The late complications included stricture of neobladder-urethra anastomosis (6%), lithiasis in neobladder (4%), ureteroileal stricture (8%), 5 renal units were lost, chronic urinary retention (5%), symptomatic metabolic acidosis (1%) and urinary infection (14%). Thirteen of these patients with late complications required surgery. At 6 months' minimum follow-up, 90% of the patients were continent during the day and 60% during the night. Overall, 36% of the patients recovered erection postoperatively; 76% of the patients with preserved neurovascular bands recovered erection. Forty-four percent of the patients claimed they had a satisfactory sexual activity postoperatively.
The Studer neobladder permits voiding through the urethra, preservation of the upper urinary tract, the urinary infection rate is acceptable, the complication rate is low and it offers patients continence rates that allow them to have a good quality of life.
自1988年以来，我院已实施了100例Studer回肠低压储尿囊手术。本文介绍了这些患者的功能结果及观察到的并发症。
对1988年至1994年接受根治性膀胱切除术并采用Studer技术进行下尿路重建的患者进行回顾性研究。所有患者均为男性，平均年龄60岁（37 - 75岁），平均随访时间18个月（6 - 72个月）。97例患者采用等蠕动回肠段作为抗反流机制，3例患者采用输尿管吻合的回肠段套叠术。90例患者采用Wallace技术进行输尿管再植，10例患者根据个人技术（H.V.）直接固定。新膀胱与尿道的吻合在原位储尿囊的第二针缝合结束时进行。根据Walsh和Mostwin（1984年）描述的技术，21例年龄小于60岁、肿瘤分期为T2 - T3a的患者保留了神经血管束。
1例患者术后早期死于败血症。早期并发症包括尿瘤（4%）、尿瘘（3%）、肠瘘（2%）、肺部并发症（4%）、盆腔血肿（1%）和肠梗阻（3%）。这些患者中只有4例需要手术解决并发症。晚期并发症包括新膀胱 - 尿道吻合口狭窄（6%）、新膀胱结石（4%）、输尿管 - 回肠狭窄（8%），5个肾单位丧失，慢性尿潴留（5%），症状性代谢性酸中毒（1%）和泌尿系统感染（14%）。这些有晚期并发症的患者中有13例需要手术。在至少6个月的随访中，90%的患者白天能自主排尿，60%的患者夜间能自主排尿。总体而言，36%的患者术后恢复勃起功能；保留神经血管束的患者中有76%恢复勃起功能。44%的患者称术后性生活满意。
Studer新膀胱可经尿道排尿，能保留上尿路，泌尿系统感染率可接受，并发症发生率低，患者的控尿率使其能拥有良好的生活质量。
