本研究采用我中心在回肠W形原位膀胱和Studer膀胱基础上改良的新式回肠原位膀胱术(Urumqi膀胱)治疗肌层浸润性膀胱癌患者8例,均为男性,平均年龄61(54~66)岁。病程1个月至3年。5例为初发患者,3例有≥2次经尿道膀胱肿瘤切除术史。6例为多发肿瘤,大小0.5~2.5 cm。2例为单发肿瘤,大小均为3.0 cm。术前经PET-CT检查无远处转移和盆腔淋巴结肿大,无上尿路积水。膀胱镜检查示尿道通畅,无可疑肿瘤。术前病理检查结果:高级别浸润性尿路上皮癌6例,肌层浸润性尿路上皮癌2例。所有手术在根治性膀胱切除术后距回盲部15 cm处截取回肠50 cm,自右侧端顺时针向内侧卷曲成近圆形,左侧末端留10 cm,其余40 cm回肠形成3段、每段约13 cm的肠管,将其去管化形成新膀胱,将末端10 cm肠管从乙状结肠前方跨过,与左侧输尿管吻合,右侧输尿管与新膀胱右侧顶部吻合,尿道与新膀胱吻合。术后随访3~12个月。4例出现轻度尿失禁,术后12个月均完全尿控;7例无输尿管反流,1例术后12个月仍有左侧输尿管轻度反流。8例术后复查排泄性膀胱造影示膀胱排空效果满意,残余尿阴性,膀胱容量250~400 ml。复查胸部CT、泌尿系CT及腹部超声示无上尿路积水,无肿瘤复发和远处转移。
In this study, a new ileal orthotopic bladder (Urumqi Bladder) modified by our center based on the ileal "W" type orthotopic bladder and Studer bladder was used on 8 patients with invasive bladder cancer. All of patients were male and aged between 54 and 66 years. The history of disease ranged from 1 month to 3 years, including 5 patients with initial onset, 3 patients with ≥2 TURBT history. 6 patients had multiple tumors, tumor size from 0.5 cm to 2.5cm. There were 2 patients with single tumor. Preoperative PET-CT examination showed no distant metastasis and pelvic lymph node enlargement, no urinary tract hydronephrosis, and cystoscopy showed no suspected tumor in the urethra. Preoperative pathological results: high-grade invasive urothelial carcinoma was found in 6 cases and muscular invasive urothelial carcinoma in 2 cases. In 8 patients, 50cm ileum was taken from 15cm away from ileocecum after radical cystectomy, which was crimped clockwise inward from the right end into a nearly circular shape, with 10cm left at the left end. The remaining 40cm ileum was formed into 3 sections of about 13cm each, which were decanted to form a storage capsule. The last 10cm intestinal tube was crossed from the front of sigmoid colon. The end of intestine was anastomosed with the left ureter. The right ureter was anastomosed with the top of the right intestine pouch, and the urethra was anastomosed with the pouch to complete the diversion of urine flow. During 3-12 months of postoperative follow-up, 4 patients had short-term mild urinary incontinence. All had complete urinary control at 12 months. 1 patient still had mild left ureter reflux 12 months after surgery, and the other 7 patients had no ureter reflux. In this group of 8 patients, postoperative excretory cystography showed satisfactory effect of bladder voiding, residual, and bladder capacity. Follow-up review of chest CT, urinary CT and abdominal ultrasound showed no hydronephrosis, and no tumor recurrence or distant metastasis.
王继鑫,闫燊燊,宋鸿文,等. 新式回肠原位膀胱术的近期疗效分析[J]. 中华泌尿外科杂志,2022,43(04):291-293.
DOI:10.3760/cma.j.cn112330-20210402-00164版权归中华医学会所有。
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王继鑫:实验操作、采集数据、论文撰写;闫燊燊、宋鸿文、李前进、刘强、马军:整理数据、分析数据;王玉杰、木拉提·热夏提:研究指导;王文光:技术支持、论文修改、经费支持

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