膀胱扩大术两种不同术式的疗效及并发症比较

doi:10.19723/j.issn.1671-167X.2019.02.018

摘要/Abstract

摘要：

目的: 通过回顾膀胱扩大术患者的病历资料并进行随访,探究肠道膀胱扩大术和小肠黏膜下层(small intestinal submucosa,SIS)组织工程补片膀胱扩大术两种手术的效果及并发症情况,为进一步治疗提供依据。方法: 对北京大学人民医院自2011年11月1日至2016年12月30日期间收治的10例接受肠道膀胱扩大术或SIS组织工程补片膀胱扩大术的患者进行回顾性分析。患者的病历资料包括:临床病史、手术方法、围手术期检查结果及并发症、术后恢复情况,并进行定期随访。肠道膀胱扩大术组6例,SIS组织工程补片膀胱扩大术组4例,分析两种手术方法的效果及并发症情况。结果: 5例行乙状结肠膀胱扩大术,1例行回肠膀胱扩大术,4例行SIS组织工程补片膀胱扩大术,10例患者均完成随访。平均手术时间(302.0±66.6) min,术中平均出血(167.0±135.0) mL。SIS组织工程补片组在手术时长、肠道恢复时间、术后住院日及引流拔除时间等方面均优于肠道膀胱扩大组。两种术式手术前后国际前列腺症状评分、膀胱过度活动症评分、国际尿失禁咨询委员会尿失禁问卷表简表、O’Leary-Sant问卷表评分均有改善。术后2例行规律清洁自家间歇导尿,2例长期留置尿管。术后短期并发症包括:2例术后感染,1例轻度肠梗阻,1例代谢性酸中毒。长期并发症包括:1例输尿管吻合口狭窄,行吻合口球囊扩张术,3例反复发作的泌尿系感染,需抗生素治疗。结论: 肠道膀胱扩大术及SIS组织工程补片膀胱扩大术对于症状的改善和上尿路功能的保护均具有确切意义,无严重并发症发生。对于难治性间质性膀胱炎/膀胱疼痛综合征患者,进行SIS组织工程补片膀胱扩大术者膀胱黏膜再生良好,术后有效缓解了患者尿频、憋尿后下腹痛的症状。但本研究患者数量较少,随访时间较短,缺乏尿动力学检查结果,尚有待前瞻对照研究,纳入更大的样本量和进行更长期的随访结果以进一步验证SIS组织工程补片在膀胱扩大术中的疗效。

关键词: 膀胱疾病, 生物相容性材料, 组织工程, 泌尿外科手术, 术后并发症

Abstract:

Objective: To compare the effectiveness and complications between enterocystoplasty and small intestinal submucosa (SIS) cystoplasty through follow-ups of patients with augmentation cystoplasty in Peking University People’s Hospital, offering alternative approach for future treatment.Methods: In this study, retrospective analyses were carried out in 10 patients who underwent enterocystoplasty or SIS cystoplasty in Peking University People’s Hospital from November 2011 to December 2016. Clinical data were collected including medical history, surgical procedures, laboratory examinations and complications. And then regular follow-ups were developed. Ten patients were separated into groups of enterocystoplasty (n=6) and SIS cystoplasty (n=4), to compare their outcomes.Results: Ten patients all completed the follow-up interview. Five cases underwent augmentation cystoplasty with sigmoid colon, one with ileum and four with SIS cystoplasty successfully. The mean operative time was (302.0±66.6) min, and blood loss was (167.0±135.0) mL. The outcomes of the group of SIS cystoplasty were better in respects of the time of operation, intestinal function recovery, postoperative hospitalization duration and drainage removal. The average scores of American Urological Association symptom score (AUASS), overactive bladder syndrome score (OABSS), International Consultation on Incontinence questionnaire short form (ICI-Q-SF), and O’Leary-Sant Questionnaire were all improved in two groups. Two cases carried clean intermittent self catheterazion and two used long-term indwelling catheter. There were three patients with dilations of renal pelvises and ureters consistently or during bladder was filling preoperatively, and the situations were not going bad after the operations. The short-term complications included two cases of postoperative infection, one case of mild intestinal obstruction and one case of metabolic acidosis. The long-term complications included one case of ureteroinstestinal anastomosis strictures, three of urinary tract infection and one of long-term metabolic acidosis.Conclusion: Enterocystoplasty and SIS cystoplasty are both effective operations to improve symptoms and protect upper urinary function, with no severe complications. Cystoscopic results showed satisfactory mucosa regeneration after SIS cystoplaty in refractory interstitial cystitis/painful bladder syndrome. But the number of patients included were quite small and the follow-up period was not long enough. Prospective control study of larger number of patients with longer follow-ups are expected to find out the effectiveness and safety of SIS cystoplasty.

Key words: Urinary bladder diseases, Biocompatible materials, Tissue engineering, Urologic surgical procedures, Postoperative complications

中图分类号:

R699.5

梁晨,张维宇,胡浩,王起,方志伟,许克新. 膀胱扩大术两种不同术式的疗效及并发症比较[J]. 北京大学学报（医学版）, 2019, 51(2): 293-297.

Chen LIANG,Wei-yu ZHANG,Hao HU,Qi WANG,Zhi-wei FANG,Ke-xin XU. Comparison of effectiveness and complications between two different methods of augmentation cystoplasty[J]. Journal of Peking University(Health Sciences), 2019, 51(2): 293-297.

图/表 3

表1

两组不同术式患者术中和术后情况"

Items	Enterocystoplasty group	SIS cystoplasty group	P value
n	6	4
ASA classification, $x ?$ ±s	1.8±0.4	1.7±0.5	0.779
Duration of operation/min, $x ?$ ±s	318.0±21.4	170.0±14.1	<0.001
Intraoperative bleeding/mL, $x ?$ ±s	216.7±147.2	92.5±78.9	0.165
Intestinal function recovery/d, $x ?$ ±s	7.2±2.6	2.8±2.9	0.034
Postoperative hospitalization duration/d, $x ?$ ±s	12.2±2.2	8.0±0.8	0.008
Removal of abdominal drainage postoperatively/d, $x ?$ ±s	8.2±2.2
Removal of pelvic drainage postoperatively/d, $x ?$ ±s	8.3±1.5	5.3±2.1	0.025
Removal of suprapubic catheter postoperatively/d, $x ?$ ±s	24.2±20.5		0.132
Removal of urinary catheter postoperatively/d, $x ?$ ±s	27.5±15.1	37.5±9.6	0.278

表1

表2

肠道膀胱扩大术及生物补片膀胱扩大术患者手术前后症状评分"

Items	AUASS	OABSS	ICI-Q-SF	O’Leary-Sant score
Enterocystoplasty (n=6)
Preoperative, $x ?$ ±s	23.0±3.7	7.4±2.4	9.4±9.0
Postoperative, $x ?$ ±s	8.4±6.1	2.6±5.8	2.2±2.0
P value	0.001	0.007	0.059
SIS cystoplasty (n=4)
Preoperative, $x ?$ ±s	17.3±2.3	7.7±1.2	3.3±5.8	28.0±1.4
Postoperative, $x ?$ ±s	7.6±4.7	3.0±1.7	0.7±1.2	7.0±0.0
P value	0.017	0.009	<0.001	0.001

表2

图1

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