【摘要翻译】应用改良回肠新膀胱的尿流改道手术：9年的经验和结果

文题：MODIFIED ILEAL NEOBLADDER FOR CONTINENT URINARY DIVERSION: FUNCTIONAL RESULTS AFTER 9 YEARS OF EXPERIENCE.
应用改良回肠新膀胱的尿流改道手术：9年的经验和结果
作者：SKOLARIKOS, ANDREAS; DELIVELIOTIS, CHARALAMBOS; ALARGOF, EUGENIOS; FERAKIS, NIKOLAOS; PROTOGEROU, VASILIOS; DIMOPOULOS, CONSTANTIN
杂志全名： Journal of Urology
年份，卷（期）: 起止页码：171(6, Part 1 of 2):2298-2301, June 2004
PMID：
英文摘要：
Purpose: We report the continence status and urodynamic findings in 59 patients who underwent radical cystectomy and orthotopic bladder reconstruction using a modified S-ileal neobladder technique between January 1993 and July 2002.
Materials and Methods: Continence status was assessed using patient interview, frequency-volume charts and the need for protective devices. Reservoir sensation, compliance, capacity and activity were assessed by enterocystometry. Post-void residual urine volume greater than 100 ml was the indication for clean intermittent self-catheterization.
Results: Daytime continence was reported by 95.5% and 100% of our patients at 1 and 5 years, respectively. Overall, 77.7% of patients reported nighttime continence at 1 year and 96.5% at 5 years. The need for a protective device decreased with time and most of the patients would have undergone the operation again. Enterocystometric capacity and maximum reservoir pressure remained remarkably stable at 391.6 versus 440 ml, and 30 versus 20 cm H2O, 6 months and 5 years after surgery, respectively. Nevertheless, median post-void residual urine volume increased from 35 ml at 6 months to 55 ml at 5 years with an increase in prevalence of patients requiring intermittent self-catheterization due to post-void residual urine greater than 100 ml from 1.8% at 6 months to 10% at 5 years.
Conclusions: Orthotopic bladder substitution with the modified S-ileal neobladder technique has an excellent functional outcome over time, resulting in high daytime and nighttime continence levels as well as high acceptability rates from our patients.

中文译文：
目的：报告1993-2002年间59例根治性膀胱切除应用改良S-回肠原位重建膀胱病人的膀胱可控性和尿动力学结果。
材料和方法：可控性状态应用病人访问，频率-容量表和是否需要保护装置来确定。应用肠膀胱计（enterocystometry，当为一种特为此类患者设计的尿动力设备，不过既然是原位膀胱，可能和一般的尿动力测定设备无大区别。--译者注）测定贮尿囊的敏感性，顺应性，容量和活动性。排尿后残余尿超过100ml为清洁间歇自家导尿的适应症。
结果：1年和5年的白天可控率分别为95.5%和100%，而夜间可控率分别为77.7%和96.5%。对保护装置的需要随时间逐渐减少，而且多数患者表示若再选择仍选择手术。肠膀胱计测定的容量和最大贮尿囊压力一直平稳，术后6月为391.6ml和30cmH2O，术后5年为440ml和20cmH2O。然而，排尿后残余尿的中位值由术后6月的35ml增加到术后5年的55ml，因残余尿大于100ml而需要清洁间歇自家导尿者由术后6月的1.8%增加到术后5年的10%。
结论：应用改良S-回肠新膀胱技术进行原位膀胱替代具有长期的良好结果，白天和夜间的可控性高，并易于为患者所接受。

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个人评论：原位膀胱的材料多由回肠和乙状结肠构成，回肠的做的多一些，乙状结肠做的少一些，孰优孰劣，尚无定论，本篇文章的结果倒是颇令人满意，不过未提供术后远期上尿路的情况，是否有肾积水，是否有返流等等，有点遗憾。具体手术方式见下贴。