IlDeal Neobladder의 임상적 특성
Clinical Characteristics of Ileal Neobladder
소속 상세정보
서성일/Seong Il Seo
조규선/변석수/김대영/이해원/김현회/최황/김시황/이상은/Kyu Seon Cho/Seok Soo Pyun/Dea Young Kim/Hae Won Lee/Hyeon Hoe Kim/Hwang Choi/Soi Hwang Kim/Sang Eun Lee
KMID : 0358319980390070704
Abstract
서론
방광적출술 후엔 필연적으로 요류전환술이 시행된다 전통적인 회장도관을 이용한 요류전
환술이 널리사용되어져 왔지만 근래에는 장관을 이용하여 정상방 광과 유사한 reservoir를
만들어 환자자신의 요도로 직접 연결하는 neobladder술식이 점점 그 영역을 넓혀가 고 있
다. 방광대치술의 목적은 충분한 용적과 낮은 관내압력으로 요를 저장하고 잔뇨없이 요를
배출할 수 있으며 대사성 이상등의 합병증이 없고 상부요로에 손상을 주지 않는 reservoir
를 만드는데 있다 저자들은 서울대학교병원 에서 회장을 이용한 neobladder 술식 으로 방광
대치술을 시행받은 환자들에 대해 임상적, 방사선학적 그리고 요류역동학적 검사를 시행하
여 Ueal neobladder의 특성을 조사하였다.
#초록#
Purpose : To evaluate clinical characteristics of ileal neobladder as orthotopic bladder
substitution, we examined the urodynamic characteristics, clinical symptoms and
radiologic findings of 11 patients who had undergone ileal nobladder substitution
following cystectomy or cystoprostatectomy.
Materials and Methods : From February 1993 to July 1996, 11 patients underwent
lower urinary tract reconstruction with ileal neobladder. Cystectomy or
cystoprostatectomy was done, and reservoirs were connected to the proximal urethra or
urethrovesical junction. Urodynamic and radiologic studies were performed to evaluate
neobladder function and upper tract. Clinical symptoms were evaluated via a detailed
patient questionaire.
Results : Mean cystometric capacity was 434m1(293-640m1). All patients voided by
Valsalva maneuver and achieved good peak flow rates(mean value was 22.6m1/sec). Of
the patients 10 emptied bladder to near completion with a mean post-void residual of
30m1, while 1 had post-void residuals of 110m1 The neobladder demonstrated good
compliance for the storage of urine Phasic neobladder contractions were present during
filling cystometrography. While the number of phasic contractions increased at higher
neobladder volumes, the mean length and mean pressure of phasic contractions were not
Increased a higher neobladder volumes. Daytime continence was obtained in all
patients(100%), while nighttime continence was achieved in 8 patients (73%). Of these 8
nighttime continent patients, 4 patients(50%) had to void at least once a night to keep
dry. No difference was found in any urodynamic parameter between nighttime continent
and incontinent patients. There was no difference in any important urodynamic
parameter between patients who had and had not received post-operative chemotherapy.
Renal function, based on serum creatinine levels, had remained stable and no significant
electrolyte or acid-base imbalance was found in all patients. Voiding cystourethrograms
obtained in 9 patients revealed 3 patients(33%) had grades Ⅱ-Ⅲ/V reflux IVP in 9
patients revealed hydronephrosis in 1/18(5.5%) of renal units.
Conclusions : Neobladder constructed from detubularized ileum achieves adequate
capacity at low pressures with a satisfactory continence rate. We conclude that
neobladder may be the best choice of urinary diversion after cystectomy in the aspect of
quality of life. (Korean J Urol 1998; 39: 704∼8)
키워드
Urinary diversion; Neobladder; lleum;
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