1、腸代膀胱尿動(dòng)力學(xué)表現(xiàn)腸代膀胱尿動(dòng)力學(xué)表現(xiàn)腸代膀胱尿動(dòng)力學(xué)表現(xiàn)20世紀(jì)80年代中期前，很少采用腸道膀胱成形術(shù)，新膀胱術(shù)也沒有成型。臨床上還沒有意識(shí)到低的膀胱并發(fā)癥的重要性，在晚期膀胱癌的治療中回腸膀胱仍然是“金標(biāo)準(zhǔn)”方法，但回腸膀胱卻顯示存在較高的后期并發(fā)癥。從社會(huì)心理學(xué)觀點(diǎn)來(lái)看，采用外部集尿器會(huì)影響患者獲得滿意的生活質(zhì)量。腸代膀胱尿動(dòng)力學(xué)表現(xiàn)腸代膀胱尿動(dòng)力學(xué)表現(xiàn)腸代膀胱尿動(dòng)力學(xué)表現(xiàn)20世紀(jì)80年代中期前，很少采用腸道膀胱成形術(shù)，新膀胱術(shù)也沒有成型。臨床上還沒有意識(shí)到低的膀胱并發(fā)癥的重要性，在晚期膀胱癌的治療中回腸膀胱仍然是“金標(biāo)準(zhǔn)”方法，但回腸膀胱卻顯示存在較高的后期并發(fā)癥。從社會(huì)心理學(xué)觀點(diǎn)來(lái)

2、看，采用外部集尿器會(huì)影響患者獲得滿意的生活質(zhì)量。20世紀(jì)80年代中期前，很少采用腸道膀胱成形術(shù)，新膀胱術(shù)也沒從20世紀(jì)80年代開始，神經(jīng)原性膀胱已經(jīng)成為腸道膀胱成形術(shù)的相對(duì)適應(yīng)證，而如今主要由于采用間斷自家導(dǎo)尿來(lái)排空膀胱的方法被廣泛接受，神經(jīng)原性膀胱患者成為施行膀胱成形術(shù)的最重要人群。腸道膀胱成形術(shù)在難治性逼尿肌過(guò)度活動(dòng)及低順應(yīng)性膀胱患者中是一種安全有效的方法，但對(duì)難治性間質(zhì)性膀胱炎患者效果不佳。可控尿流改道和新膀胱已經(jīng)成為膀胱癌膀胱全切后的一種經(jīng)典的改道方式，在高危的膀胱癌患者中回腸膀胱仍是主要的改道方式。從20世紀(jì)80年代開始，神經(jīng)原性膀胱已經(jīng)成為腸道膀胱成形術(shù)的腸道成行手術(shù)和新膀胱的目的

3、在于形成一個(gè)低壓、高容量的儲(chǔ)尿囊，儲(chǔ)尿囊的排空或依靠間斷自家導(dǎo)尿(intermittent catheterization)，或排尿反射(activation of the micturition reflex)，或腹壓排尿(straining)。(Case 1、2、3)新膀胱的手術(shù)方法很多。偶爾情況下，當(dāng)膀胱癌患者施行較大范圍的膀胱部分切除術(shù)時(shí)可進(jìn)行膀胱擴(kuò)大成形。(Case 6)當(dāng)不能通過(guò)尿道間斷導(dǎo)尿時(shí)，帶可控的能導(dǎo)尿的輸出道的尿流改道方式是一種選擇，但有時(shí)合并癥較明顯。施行膀胱擴(kuò)大手術(shù)的患者若不能經(jīng)尿道導(dǎo)尿時(shí)也可做可控的輸出道。腸道成行手術(shù)和新膀胱的目的在于形成一個(gè)低壓、高容量的儲(chǔ)尿囊，U

4、rodynamic Findings in Orthotopic Ileocecal and Ileal NeobladderComparison of Clinical and Urodynamic Outcome in Orthotopic Ileocecal and Ileal Neobladder. Europeon Urology, 2003, 43(3): 258-262. Urodynamic Findings in Orthoto35歲女性脊髓多發(fā)性硬化患者，7年前因難治性逼尿肌-外括約肌協(xié)同失調(diào)(DESD)施行回腸膀胱擴(kuò)大成形術(shù)。她每日導(dǎo)尿4次，并且能控尿。Augmentat

5、ion enterocystoplasty in a 35-year-old woman with exacerbating, remitting multiple sclerosis who underwent the operation 7 years earlier because of refractory detrusor-external sphincter dyssynergia (DESD). She is on intermittent catheterization 4 times a day and remains continent.35歲女性脊髓多發(fā)性硬化患者，7年前

6、因難治性逼尿肌-外括約肌Urodynamic tracing shows and acontractile bladder with a capacity of over 750ml, FSF435ml, 1st urge650ml, severe urge750ml.Urodynamic tracing shows and aX-ray obtained at 550ml. X-ray obtained at 550ml. 43歲女性，難治性特發(fā)性膀胱過(guò)度活動(dòng)癥(OAB)。患者于18個(gè)月前施行回腸膀胱擴(kuò)大術(shù)。Urodynamic study in a 43-year-old woman wh

7、o underwent ileal augmentation cystoplasty 18 months earlier because of refractory idiopathic overactive bladder (OAB).43歲女性，難治性特發(fā)性膀胱過(guò)度活動(dòng)癥(OAB)。UrodyUrodynamic study: FSF=415ml, 1st urge=574ml, and severe urge=600ml. Pressure flow study: Qmax=8ml/s, PdetQmax=43cmH2O, Pdetmax=54cmH2O, voided volume=2

8、16ml, PVR=975ml. Urodynamic study: FSF=415ml, 1After the catheter was removed, in the privacy of the bathroom, she voided to completion with a bell shaped curve and Qmax=25ml/s.VOID: 25/462/200. This corresponds to a mild grade 1 urethral obstruction on the Blaivas-Groutz nomogram.After the catheter

9、 was removed54歲男性患者，2年前因浸潤(rùn)性膀胱癌行Studer回腸新膀胱術(shù)。患者白天每46小時(shí)用腹壓排尿1次，夜間不排尿，有時(shí)有遺尿，但否認(rèn)其他的下尿路癥狀(LUTS)。Ileal neobladder. This is a 54-year-old man 2 years status post ileal (studer) neobladder for invasive bladder cancer. He voids by, straining, about every 46 hours during the day and does not have nocturia. He

10、 has occasional enuresis, but denies any other lower urinary tract symptoms (LUTS).54歲男性患者，2年前因浸潤(rùn)性膀胱癌行Studer回腸新膀胱Urodynamic tracing. FSF=559ml, 1st urge=1028ml, severe urge=1297ml, and bladder capacity=1311ml. The electromyography (EMG) channel was not working properly during this study.Urodynamic t

11、racing. FSF=559ml,Uroflow without the catheter shows a straining pattern.Uroflow without the catheter sStraining to void. Straining to void. 62歲男性患者，施行保留神經(jīng)的膀胱前列腺切除術(shù)，采用Studer方法重建回腸新膀胱。患者按計(jì)劃大約每天排尿6次，從來(lái)沒有排尿感。白天及夜間均無(wú)尿失禁。Studer neobladder: 62-year-old man status post nerve sparing cystoprostatectomy and

12、construction of ileal neobladder with Studer limb. He voids about 6 times a day, by design, but never senses an urge to void. He is never incontinent, day or night.62歲男性患者，施行保留神經(jīng)的膀胱前列腺切除術(shù)，采用StudCystogram obtained 3 weeks postoperatively with 100ml in the bladder.Straining to void. Cystogram obtained

13、 3 weeks pos另一新膀胱患者3年后尿動(dòng)力學(xué)檢查圖：In the filling phase of the study, he did not perceive the urge to void, but felt a vague fullness beginning at about 900ml. He voided voluntarily by marked abdominal straining at a bladder volume of about 1l. Qmax=11ml/s, voided volume=492ml, and PVR=510ml. 另一新膀胱患者3年后尿

14、動(dòng)力學(xué)檢查圖：In the filliA magnified view during voiding. A magnified view during voidinX-ray obtained during uroflow. X-ray obtained during uroflow.Uroflow obtained prior to the urodynamic study show a very different pattern than that seen during the study. VOID: 13/333/0.Uroflow obtained prior to the 87

15、歲男性患者，因膀胱移行細(xì)胞癌(T2N0M0)施行“膀胱部分切除術(shù)+膀胱擴(kuò)大術(shù)”。術(shù)后6個(gè)月出現(xiàn)雙側(cè)膀胱輸尿管反流及無(wú)癥狀性逼尿肌過(guò)度活動(dòng)。Bilateral vesicoureteral reflux (VUR) and asymptomatic detrusor overactivity in an 87-year-old man 6 months status post partial cystectomy and augmentation cystoplasty for transitional cell carcinoma of the bladder (T2,N0,M0).87歲男性

16、患者，因膀胱移行細(xì)胞癌(T2N0M0)施行“膀胱部Urodynamic study: There are multiple low magnitude involuntary detrusor contractions during bladder filling that do not result in incontinence.FSF=750ml, 1st urge=950ml, severe urge=1001ml, PVR=850ml。Urodynamic study: There are mu腸代膀胱尿動(dòng)力學(xué)表現(xiàn)課件68歲男性患者，因膀胱癌在本院行“全膀胱切除+Sigma直腸膀胱術(shù)”。術(shù)后半年行尿動(dòng)力學(xué)檢查。68歲男性患者，因膀胱癌在本院行“全膀胱切除+Sigma直腸尿動(dòng)力學(xué)檢查顯示：FSF=110ml，1st urge=235ml，severe urge=465ml。灌注至180ml、220ml、254ml時(shí)患者出現(xiàn)少量漏尿。灌注過(guò)程中代膀胱壓力與腹壓同步上升，至465ml時(shí)囑其排尿，排出尿量=284ml。尿動(dòng)力學(xué)檢查顯示：FSF=110ml，1st urge=23排尿期圖形：Qmax=74.2ml/s，達(dá)峰時(shí)間=4s。 排尿期圖形：Qmax=74.2ml/s，達(dá)峰時(shí)間=4s。 59歲女性患者，三年前因膀胱癌在外院行“全膀胱切