摘要
目的 观察乙状结肠直肠膀胱术作为可控性尿流改道的临床效果。方法 选择 38例膀胱癌患者 ,行膀胱全切术。以乙状结肠直肠交界为中点 ,纵行剖开肠管 2 0～ 2 4cm ,成形为储尿囊。输尿管以黏膜下隧道方式作抗逆流吻合。利用肛门括约肌控制排尿。术后随访 3～ 6 0个月 (平均30个月 )。结果 肠袋最大储尿容量 4 0 0～ 6 5 0ml(平均 5 15 6ml) ,基础压力 8～ 2 3cmH2 O(平均16 5cmH2 O ,1cmH2 O =0 0 98kPa) ,最大充盈压力 12～ 33cmH2 O(2 1 3cmH2 O)。在充盈过程中肠袋的顺应性良好。结论 该术式简单易行 ,易于掌握。手术时间短 ,术后并发症少 ,临床效果肯定。是一种比较好的可控性尿流改道方法。
Objective To investigate the clinical outcome of sigma rectum pouch as a continent form of urinary diversion. Methods The clinical data of 38 patients, 32 males and 7 females, aged 53.2 (42-68) with muscle-invading bladder carcinoma who underwent a Mainz pouch II procedure after radical cystectomy 1996-2001 were analyzed. The intestine was incised over a length of 20-24 cm with the junction of sigmoid colon and rectum as the midpoint so as to create a low-pressure reservoir for urine and side-to-side anastomosis was performed on the posterior borders of the rectosigmoid wall. Submucosal tunnel technique was employed in antireflux urethral implantation. The patients were followed up for 7-60 months with a mean of 30 months postoperatively. Results Continence has been achieved in all the 38 patients with a micturition frequency of 3-5 times during daytime and 0-3 times at night. The mean volume of pouch was 515.6 ml (400-650 ml). The basal intra-reservoir pressure was 8-23 cm H 2O(mean 16.5 cm H 2O,1 cm H 2O=0.098 kPa),the highest peak pressure was 12-33 cm H 2O(mean 21.3 cm H 2O). Conclusion A modified sigmoid rectal pouch procedure provides a reservoir with a higher capacity and lower pressure without a reflux to the upper urinary tract and descending colon with lower incidence of complication, it is also a better alternative diversion procedure that would be easily accepted by surgeons and patients.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2004年第13期1096-1097,共2页
National Medical Journal of China
基金
卫生部回国留学人员启动基金资助项目
