| Objective: To investigate the effectively operation method that the patient with infiltrated bladder cancer can urinate in situ after total cystectomy. Method: 51 man-patient (mean age 66 years old,range 42-72 years old) who had diagnosed as the infiltrated bladder cancer (T2,T3 infiltration bladder cancer,T1G3 recur bladder cancer post-TUR, glandular carcinoma,squamous cell carcinoma and so on )without bladder trigone zone and vesical neck infiltration, standard intestines prepared preoperation, inhalation anestheties and epidural block, middle incision in the inferior abdomen, a low-pressure anti-reflu Ileal neobladder operation is undertaken After total cystectomy. First of all, insect ileal 50 cm with intact mesentery at 20 cm away from appendix. Then reconstruct the continuous of the ileal, Proximal ileal leaved 8 cm, the rest arrange as "U"shape, sewed up the ileal near it's mesentery side, formed the neo-bladder by sewing up the ileal wall as "b"shape with absorbable line. Then make double ureter link to input-part ileal in an anti-reflu way. At last , cut a hole of diameter 5 mm in the lowest of the ileal neo-bladder, connect it to urethra with 6-stitchs, insided a F22 size urine lead tube. So the neo-bladder is undertaken anastomosis with urethra in low part , in order to reconstruct the continuous of the urethra. Keeping up the ileal neo-bladder drainage unobstructed postoperation, it is only the patients can preserve urine in the ileal neo-bladder for 1 hour after a long time's practice, removed the urine lead tube. And practice urinate by himself continually. Result: Among 51 cases, mean operative time was 6.5 hours ( range 5.5-8.5 hours ), mean intraoperative blood loss was 650ml ( range 300-1200ml ) , and transfusion was needed in 31 case, mean transfusion blood was 600ml ( range 200-800ml ). Perioperative complications included stress ulcer in 6, recovered after treatment, abdomen wall leaking urine after extract ureter support tube postoperation, recovered after redrainaged, All patients have been followed-up postoperation except to 2 patients died of cancer metastasis. the follow-up period is 8-44 months,mean time is 24 months . All patients have not any lumbago, fever, blood urine, B-ultrasonic check didn't find any hydronephrosis . it is not found serious metabolize disorder case or less than that happens in other urinary diversion (ileal-bladder, colon-bladder can result in hy-chlorine metabolism acidosis postoperation , ileal-bladder is 10%-70%, ureter-colon bladder is 80% , ileal-colon bladder 10%-15% , respectively.) Urinary contient rates at 3 months and 6 months postoperatively day time were 91% and 100% ,the night time 87% and 89% ,respectively. The upper urinary tract function was excellent. Conclusion: all 51 patients operation according to foregoing statement strictly, B-ultrasonic check indicate that the shape of the ileal neo-bladder is regularity and the no ureter re-flu. follow-up postoperation indicated that neo-bladder is better than bricker ileal-bladder (so-called golden standard operation in urinary diversion ) in rising patient's life quality, the low-pressure anti-reflu neo-bladder operation is a better method to solve the complications after total cystectomy. so, It is recommended to be widely used in selective candidates. But it is needed long time to test the result and complication of the neo-bladder postoperation for it's applied to clinical shortly, there is nothing better than original bladder. It cann't expand adapt range of totalcystectomy freely for the appearing of the neo-bladder operation .
|
PDF Full Text Request