Ileocolic Neobladder 의 5년간 경험
The Ileocolic Neobladder: 5-Year Experience in 49 Male Bladder Cancer Patients
이건섭, 양일권, 방재홍,
소속 상세정보
이건섭 ( )
가톨릭대학교 의과대학 비뇨기과학교실
양일권 ( )
가톨릭대학교 의과대학 비뇨기과학교실
방재홍 ( )
가톨릭대학교 의과대학 비뇨기과학교실
KMID : 0358319970380111210
Abstract
결론
저자들은 1991년 5월부터 1996년 4월까지 5년간 방광암 환자에서 근치적 방광적출술후의
요로전환술로 49례의 ileocolic neobladder를 시행하며 이를 대상으로 술후 합병증과 요역동
학적 검사를 분석하였다. 술후 초기 합병증은 8례(16.7%)에서 발생하였으나 이중 7례는
neobladder와 연관이 없는 합병증이었으며 대부분 보존적으로 치유되었다. 술후 후기 합병
증은 10례(20.9례)에서 발생되었으며 요관-장 문합부위의 협착이 5례 (10.4%)로 가장 많았
고 요관 확장술 및 요관-장 재문합술로 치료하였다. 술후 6개월에 검사한 요역동학적 검사
에서 neobladder의 평균 최대용적은 553±75.3 ml, 평균 최대내압은 24.2±6.7 ㎝
H2O, 평균 최대요도폐쇄압 51.4±12.7 ㎝H2O, 평균 최대요속
11.3±6.5m1/sec 및 평균 잔뇨량 46.5±8.1 ml로써 비교적 큰 용적과 낮은 내압을 보였고 주
간 요자제율은 100%, 야간 요자제율은 91.7%를 보였다.
이상의 결과로 저자들이 시행한 ileocolic neobaldder는 수술후 합병증의 빈도가 기존의 다
른 요로전환술과 비교하여 큰 차이가 없으며 낮은 reservoir 내압과 높은 요도 폐쇄압으로
요자제를 유지할 수 있고 상두요로를 보호할 수 있어 방광적출술이 요구되는 비교적 젊고
전신 상태가 양호한 환자에서 권할만한 수술법으로 생각된다.
#초록#
Since 1991 the orthotopic ileocolic neobladder after radical cystoprostatectomy for
bladder cancer has been performed at our hospital. We report our 5 year experience of
ileocolic neobladder with focus on complications, urodynamic data and continence status.
Between May 1991 and April 1996, a total of 49 men underwent bladder replacement
with an orthotopic ileocolic neobladder following radical cystectomy for management of
invasive bladder cancer.
Mean age of the patient was 53.2 years (range 34∼68). Mean follow up was 42
months (range 4∼63). There was one perioperative death due to sepsis who had been
suffered from diabetes mellitus. Early complications were developed in 8 patients(16.7%);
neobladder leak in 1(2.1%), wound infection in 2 (4.2%), wound dehiscence in 2 (4.2%),
prolonged ileus in 1 (2.1%), and pneumonia in 1 (2.1%). Neobladder-related late
complications requiring rehospitalization were noted in 7 patients (14.6%); cecourethral
anastomosis site stricture in 1 (2.1%) which was treated endoscopically, urethral
strictures at the reimplantation site in 5 (7 renal unites, 10.4%) which were successfully
treated with balloon dilation in 4 patients and with open revision in 1 patient, and
neobladder perforation in 1 (2.1%) which was managed conservatively without sequelae.
Urethral recurrence was noted in 1 patient and has been managed with M-VAC
chemotherapy. There was no vesicoureteral reflux in any patient.
Urodynamic study of the neobladder at 6 months showed a low pressure (mean 24.2
㎝ H2O), large capacity (mean 553 ml) and an adequate maximal urethral
closure pressure(mean 51.3 ㎝ H2O). The peak flow rate in all patients
was good (mean 11.3m/sec). All patients were dry during daytime but mild stress
urinary incontinence was noted in 5 patients (10.4%) and nighttime continence was good
in 91.7% at 6 months. Our results indicate that orthotopic ileocolic neobladdcr provides
good functional results and would be one of the ideal urinary diversion for bladder
substitution after radical cystoprostatectomy and will continue to be our procedure of
choice in selected male bladder cancer patients.
키워드
Bladder cancer; Ileocolic neobladder;
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