Long-term results of orthotopic neobladder reconstruction after radical cystectomy
Long-term results of orthotopic neobladder reconstruction after radical cystectomy
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DOI：
10.1046/j.1464-410x.2003.04131.x
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发表时间：
2003-04-01
影响因子：
4.5
通讯作者：
Pantvaidya, GH
中科院分区：
文献类型：
--
作者：
Kulkarni, JN;Pramesh, CS;Pantvaidya, GH
在一项回顾性研究中，评估根治性膀胱切除术后新膀胱重建的长期结果，因为这是肌层浸润性膀胱癌的标准治疗方法，我们检索了1988年至1998年期间接受根治性膀胱切除术和原位新膀胱替代术治疗的所有肌层浸润性膀胱移行细胞癌患者的数据。记录所有围手术期和长期并发症。对患者的排尿方式、排尿频率和排尿次数进行评估，并记录完整的尿动力学资料。在研究期间，共有102例患者接受了根治性膀胱切除术和原位新膀胱重建术;他们的平均（范围）随访时间为73（36-144）个月。35例患者行回盲部新膀胱替代，34例患者行乙状结肠替代，33例患者行回肠替代。32例患者（31%）发生了早期并发症，但仅9例（9%）需要开放手术干预。术后死亡率为3.9%。31例患者（30%）发生晚期并发症，主要由输尿管肠狭窄和膀胱尿道狭窄引起（各9%）。大多数患者有白天（89%）和夜间（78%）睡眠障碍。平均最大贮袋容量（mL）和贮袋容量压力（cmH（2）O）分别为562.5和23（回盲部）、542和17.8（乙状结肠）以及504和19.1（回肠）;平均排尿后残留量分别为29、44和23 mL。9例回盲部新膀胱患者，20例乙状结肠和回肠新膀胱患者，需要清洁间歇性导管插入术。24例患者复发，其中20例死亡。原位新膀胱重建需要复杂的手术，但在适当选择的患者中，早期和晚期并发症的发生率是可以接受的。它提供了令人满意的治疗，而不影响治愈率。
To assess, in a retrospective study, the long-term results of neobladder reconstruction after radical cystectomy, as this is the standard of care for muscle-invasive bladder cancer.Data were retrieved for all patients with muscle-invasive transitional cell carcinoma of the bladder treated by radical cystectomy and orthotopic neobladder substitution between 1988 and 1998. All perioperative and long-term complications were recorded. The voiding pattern, frequency of micturition and continence were assessed, and a complete urodynamic profile recorded.In all, 102 patients underwent radical cystectomy with orthotopic neobladder reconstruction in the study period; their mean (range) follow-up was 73 (36-144) months. Neobladder substitution was with an ileocaecal segment in 35 patients, sigmoid colon in 34 and ileum in 33. Early complications occurred in 32 patients (31%) although open surgical intervention was required in only nine (9%). The death rate after surgery was 3.9%. Late complications occurred in 31 patients (30%) and were primarily caused by uretero-enteric and vesico-urethral strictures (9% each). Most patients had daytime (89%) and night-time (78%) continence. The mean maximum pouch capacity (mL) and pouch pressure at capacity (cmH(2) O) were 562.5 and 23 (ileocaecal), 542 and 17.8 (sigmoid) and 504 and 19.1 (ileal), respectively; the mean postvoid residual was 29, 44 and 23 mL, respectively. Nine patients with ileocaecal neobladders, and 20 and seven with sigmoid and ileal neobladders, required clean intermittent catheterization. Twenty-four patients had recurrence of disease, of whom 20 died.Orthotopic neobladder reconstruction requires complex surgery but has an acceptable early and late complication rate in properly selected patients. It provides satisfactory continence without compromising cure rates.