目的探讨膀胱全切原位W形回肠代膀胱术优缺点。方法120例男性膀胱癌患者,其中浸润性膀胱移行细胞癌99例,移行细胞癌伴部分鳞化8例,移行细胞癌伴腺癌及鳞癌3例,腺癌6例,鳞癌4例,均行膀胱全切原位W形回肠代膀胱术。膀胱全切采用顺行、逆行相结合的方法。截取末段回肠,排列成W形,褥式缝合制作储尿袋。输尿管以乳头法包埋术种植。结果手术时间,前50例为210~300 m im,平均270 m in;后70例为110~205 m in,平均143 m in。术后91例获得随访,随访2~88个月,平均30个月,85例白天可控制排尿,其中71例夜间可控制排尿。9例术后发生输尿管扩张,7例合并轻度肾积水,2例合并中度肾积水,2例肾功能轻度异常。45例行膀胱造影仅1例发生右侧输尿管返流。术后3个月复查出现低血钾者6例,余85例血电解质均在正常范围。20例患者行尿动力检查,尿流曲线呈持续型12例,间歇型8例;膀胱尿道造影显示尿流持续型代膀胱颈口呈漏斗形,排尿时开放良好,而尿流间歇形代膀胱颈口不呈漏斗形或排尿时颈口开放欠佳。结论膀胱全切原位W形回肠代膀胱术手术时间短,操作简单,出血少,并发症少,原位W形回肠代膀胱有较好的储尿和排尿功能,电解质紊乱发生率低。 Objective To investigate the advantages and disadvantages of total bladder incision in situ W-shaped ileal neobladder. Methods A total of 120 patients with bladder cancer were enrolled. Among them, 99 were invasive bladder transitional cell carcinoma, 8 transitional cell carcinoma with partial squamous cell carcinoma, 3 transitional cell carcinoma with adenocarcinoma and squamous cell carcinoma, 6 adenocarcinoma, 4 squamous cell carcinoma, Totally bladder resection in situ W-shaped ileal bladder surgery. Total bladder resection using cis, retrograde combination of methods. Interception of the distal ileum, arranged in a W-shaped, mattress-type suture storage bag. Ureter implantation with nipple cultivation. Results The operation time ranged from 210 m to 300 m in the first 50 cases, with an average of 270 m in. The last 70 cases ranged from 110 to 205 m in with an average of 143 m in. Ninety-one patients were followed up for 2 to 88 months (average 30 months). Eighty-five patients were able to control urination during the day, of which 71 were able to control urination at night. Nine cases had ureteral dilatation, 7 cases had mild hydronephrosis, 2 cases had moderate hydronephrosis and 2 cases had mild renal dysfunction. 45 cases of bladder cystography occurred in only 1 case of right ureteral reflux. 6 months after the onset of hypokalemia, more than 85 cases of blood electrolytes were in the normal range. Twenty patients underwent urodynamics. The urinary flow curve was consistent in 12 cases and intermittent in 8 cases. Urinary bladder flow was well-developed when urinary flow was continuous, Neck not funnel-shaped or urination neck opening poor. Conclusions The total bladder incision in situ W-shaped ileal neobladder has the advantages of short operation time, simple operation, less bleeding and fewer complications. The in situ W-shaped ileal urinary bladder has better functions of urinating and urinating and the incidence of electrolyte imbalance is low.