當前1頁，總共27頁。（優選）腸代膀胱的尿動力學表現當前2頁，總共27頁。從20世紀80年代開始，神經原性膀胱已經成為腸道膀胱成形術的相對適應證，而如今主要由于采用間斷自家導尿來排空膀胱的方法被廣泛接受，神經原性膀胱患者成為施行膀胱成形術的最重要人群。腸道膀胱成形術在難治性逼尿肌過度活動及低順應性膀胱患者中是一種安全有效的方法，但對難治性間質性膀胱炎患者效果不佳。可控尿流改道和新膀胱已經成為膀胱癌膀胱全切后的一種經典的改道方式，在高危的膀胱癌患者中回腸膀胱仍是主要的改道方式。當前3頁，總共27頁。腸道成行手術和新膀胱的目的在于形成一個低壓、高容量的儲尿囊，儲尿囊的排空或依靠間斷自家導尿(intermittentcatheterization)，或排尿反射(activationofthemicturitionreflex)，或腹壓排尿(straining)。(Case1、2、3)新膀胱的手術方法很多。偶爾情況下，當膀胱癌患者施行較大范圍的膀胱部分切除術時可進行膀胱擴大成形。(Case6)當不能通過尿道間斷導尿時，帶可控的能導尿的輸出道的尿流改道方式是一種選擇，但有時合并癥較明顯。施行膀胱擴大手術的患者若不能經尿道導尿時也可做可控的輸出道。當前4頁，總共27頁。UrodynamicFindingsinOrthotopicIleocecalandIlealNeobladderComparisonofClinicalandUrodynamicOutcomeinOrthotopicIleocecalandIlealNeobladder.EuropeonUrology,2003,43(3):258-262.當前5頁，總共27頁。Case135歲女性脊髓多發性硬化患者，7年前因難治性逼尿肌-外括約肌協同失調(DESD)施行回腸膀胱擴大成形術。她每日導尿4次，并且能控尿。Augmentation

enterocystoplastyina35-year-old

womanwithexacerbating,

remitting

multiplesclerosiswhounderwent

theoperation7yearsearlierbecause

ofrefractorydetrusor-external

sphincterdyssynergia(DESD).She

isonintermittentcatheterization

4timesadayandremains

continent.當前6頁，總共27頁。Urodynamictracingshowsandacontractilebladderwithacapacityofover750ml,FSF＝435ml,1sturge＝650ml,severeurge＝750ml.當前7頁，總共27頁。X-rayobtainedat550ml.當前8頁，總共27頁。Case243歲女性，難治性特發性膀胱過度活動癥(OAB)。患者于18個月前施行回腸膀胱擴大術。Urodynamicstudyina43-year-oldwomanwhounderwentilealaugmentationcystoplasty18monthsearlier

becauseofrefractoryidiopathicoveractivebladder(OAB).當前9頁，總共27頁。Urodynamicstudy:FSF=415ml,1sturge=574ml,andsevereurge=600ml.Pressureflowstudy:Qmax=8ml/s,Pdet@Qmax=43cmH2O,Pdetmax=54cmH2O,voidedvolume=216ml,PVR=975ml.當前10頁，總共27頁。Afterthecatheterwasremoved,intheprivacyofthebathroom,shevoidedtocompletionwithabellshapedcurveandQmax=25ml/s.VOID:25/462/200.Thiscorrespondstoamildgrade1urethralobstructionontheBlaivas-Groutznomogram.當前11頁，總共27頁。Case354歲男性患者，2年前因浸潤性膀胱癌行Studer回腸新膀胱術。患者白天每4～6小時用腹壓排尿1次，夜間不排尿，有時有遺尿，但否認其他的下尿路癥狀(LUTS)。Ilealneobladder.Thisisa54-year-oldman2yearsstatuspostileal(studer)neobladderforinvasivebladder

cancer.Hevoidsby,straining,aboutevery4~6hoursduringthedayanddoesnothavenocturia.Hehasoccasional

enuresis,butdeniesanyotherlowerurinarytractsymptoms(LUTS).當前12頁，總共27頁。Urodynamictracing.FSF=559ml,1sturge=1028ml,severeurge=1297ml,andbladdercapacity=1311ml.Theelectromyography(EMG)channelwasnotworkingproperlyduringthisstudy.當前13頁，總共27頁。Uroflowwithoutthecathetershowsastrainingpattern.當前14頁，總共27頁。Strainingtovoid.

當前15頁，總共27頁。Case462歲男性患者，施行保留神經的膀胱前列腺切除術，采用Studer方法重建回腸新膀胱。患者按計劃大約每天排尿6次，從來沒有排尿感。白天及夜間均無尿失禁。Studerneobladder:62-year-oldmanstatuspostnervesparingcystoprostatectomyandconstructionofilealneobladderwithStuderlimb.Hevoidsabout6timesaday,bydesign,butneversensesanurgetovoid.Heisneverincontinent,dayornight.當前16頁，總共27頁。Cystogramobtained3weekspostoperativelywith100mlinthebladder.Strainingtovoid.

當前17頁，總共27頁。Case5

另一新膀胱患者3年后尿動力學檢查圖：Inthefillingphaseofthestudy,hedidnotperceivetheurgetovoid,butfeltavaguefullnessbeginningatabout900ml.Hevoidedvoluntarilybymarkedabdominalstrainingatabladdervolumeofabout1l.Qmax=11ml/s,voidedvolume=492ml,andPVR=510ml.當前18頁，總共27頁。Amagnifiedviewduringvoiding.當前19頁，總共27頁。X-rayobtainedduringuroflow.當前20頁，總共27頁。Uroflowobtainedpriortotheurodynamicstudyshowaverydifferentpatternthanthatseenduringthestudy.VOID:13/333/0.當前21頁，總共27頁。Case687歲男性患者，因膀胱移行細胞癌(T2N0M0)施行“膀胱部分切除術+膀胱擴大術”。術后6個月出現雙側膀胱輸尿管反流及無癥狀性逼尿肌過度活動。Bilateralvesicoureteralreflux(VUR)andasymptomaticdetrusoroveractivityinan87-year-oldman6monthsstatuspostpartialcystectomyandaugmentationcystoplastyfortransitionalcellcarcinomaofthebladder(T2,N0,M0).當前22頁，總共27頁。Urodynamicstudy:Therearemultiplelowmagnitudeinvoluntarydetrusorcontractionsduringbladderfillingthatdonotresultinincontinence.FSF=750ml,1sturge=950ml,severeurge=1001ml,PVR=850ml。當前23頁，總共27頁。當前24頁，總共27頁。Case7

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”。術