探讨拖靠吻合法在腹腔镜下根治性全膀胱切除加原位新膀胱术中新膀胱与尿道吻合中的应用。

2016年1月至2019年6月，我们对南昌大学第二附属医院22例浸润性膀胱癌患者行腹腔镜根治性膀胱全切加原位新膀胱术，采用拖靠吻合法行新膀胱与尿道的吻合。

20例男性患者均在腹腔镜下完成根治性全膀胱切除术，缝合时间为10~18 min，平均15 min。术后第4天拔除引流管，因1例术后出现尿瘘，第7天停止并拔除引流管。常规术后2周拔除导尿管，20例患者均无尿潴留情况发生，无排尿困难。9例出现尿失禁，3例1周内恢复，4例4周恢复，2例8周恢复。8周后在膀胱镜下拔除双J管，见储尿囊尿道吻合处宽敞、光滑平坦，无狭窄。12周后行尿道造影提示吻合口处宽畅、平坦，无尿瘘；超声测残余尿均<15 ml，最大尿流率平均为19.3 ml/s。术后随访3~24个月，平均16个月。所有患者12周后都恢复尿控，控尿情况均较理想；未出现尿道狭窄，吻合口无肿瘤复发。

尿道拖靠吻合法操作简便，可有效缩短新膀胱与尿道的吻合时间，学习曲线短，疗效确切，具有较高的临床应用价值。

To investigate the effectiveness and feasibility of neobladder-urethra drag-and-bond anastomosis in the laparoscopic radical cystectomy and orthotopic ileal neobladder.

Neobladder-urethra anastomosis on 22 patients with invasive bladder cancer who underwent laparoscopic radical cystectomy and orthotopic ileal neobladder formation from January 2016 to July 2019 in the Second Affiliated Hospital of Nanchang Univrsity were performed.

All patients underwent the novel anastomosis for neobladder and urethra. It took 10-18 minutes with an average of 15 minutes for the neobladder-urethra anastomosis. The JP(Jackson-Pratt) drain was removed in all patients on the fourth day except one patient whose drain was removed on the seventh day due to urine leak. Foleys catheter was removed in all patients in 2 weeks postoperation. All patients voided spontaneously without dysuria. Nine patients (9/20) developed urinary incontinence. Of these nine patients, three patients recovered in two week, four patients recovered in four weeks, and two patients recovered in eight weeks. Double J stents were removed via cystoscopy after eight weeks. In cystoscopy, the area of the neobladder-urethra anastomosis appeared patent and flat in all cases without obstruction. After 12 weeks of surgery, the residual bladder volume of the neobladder was less than 15 ml by B-ultrasound and the maximum urine flow rate was 19.3 ml/s on average, the anastomotic site appeared open and flat on retrograde urethrogram without leak-urine with 3-14 month-follow-up.

The neobladder-urethra drag-and-bond anastomosis in laparoscopic radical cystectomy and the neobladder-urethra anastomosis was safe, effective, simple and feasible, with a short learning curve and good outcomes.