可控性回结肠膀胱术远期疗效观察

评价可控性回结肠膀胱手术的远期疗效。方法对２０例回结肠膀胱术术后病人的可控性、尿动力学、血清电解质、肾功能等进行随访观察。结果２０例随访６－１１８个月，平均６２个月。白天可控率１００％，夜间可控率９５％。贮尿囊容量３８０－６６０ｍｌ，平均５８０ｍｌ。     

可控性膀胱术与回肠新膀胱术(附68例报告)

目的　评价不同术式可控性膀胱术及回肠新膀胱术的疗效。　方法　对 6 8例膀胱全切除术后患者采用 4种可控性尿流改道及回肠新膀胱术式 ,术后对患者控尿、导 (排 )尿 ,贮尿囊容积、内压 ,影像学及血生化资料进行比较。　结果　回肠套叠式输出道 3例中有 2例部分脱套致术后尿失禁 ,需再次手术 ;缩窄末端回肠式输出道 44例控尿均良好 ,除 1例插管困难外余均能用 16～ 2 0F尿管自行导尿。去管折叠式贮尿囊 39例 ,其中回肠贮尿囊 3例、结肠 2 2例、回结肠 14例 ,能达到低压贮尿囊要求 ,但早期有 8例发生贮尿囊过度扩张 ,容量 1470～ 16 5 0ml;去带结肠贮尿囊 8例 ,容量 430～6 0 0ml,充盈压 30～ 45cmH2 O(1cmH2 O =0 .0 98kPa) ,有蠕动波 ,术后早期有 2例尿漏。回肠新膀胱2 1例 ,容量 35 0～ 46 0ml,充盈压 12～ 2 0cmH2 O ,日间尿失禁 1例 ,夜间尿失禁 2例 ,其余无尿失禁。　结论　盲升结肠 30cm剖开对折成形可控性膀胱可满足低压贮尿囊要求 ,去带结肠贮尿囊由于易发生术后尿漏或粘连 ,内压较高 ,不够理想。缩窄末段回肠式输出道控尿效果好、内腔大、插管顺利、并发症少 ,明显优于回肠套叠输出道。回肠新膀胱术贮尿排尿功能良好 ,术后生活质量高 ,但应严格选择手术适应证。     

正位可控去带盲结肠膀胱加回肠抗反流术

目的：探讨正位可控去带盲结肠膀胱加回肠抗反流术的临床效果。方法：采用膀胱全切正位可控去带盲结肠膀胱加末段回肠抗反流术治疗膀胱癌20例。结果：随访9～42个月，白天均可控制排尿，14例夜间能白控排尿，6例夜间有尿失禁。尿动力学检查：12个月贮尿囊平均最大容量350ml，平均最大囊内压3．16kPa，剩余尿量为16ml，平均最大尿流率19．2ml／s。贮尿囊造影及IVU显示2例有双侧输尿管反流，无输尿管狭窄和肾积水。血电解质及肾功能正常。结论：正位可控去带盲结肠膀胱加末段回肠抗反流术操作简单，并发症少，疗效好，是一种较理想的膀胱替代术。     

去带可控盲结肠膀胱术的疗效观察（附30例报告）

目的 评价去带可控盲结肠膀胱术的疗效。方法 采用膀胱全切去带可控盲结肠膀胱术治疗膀胱癌30例。结果 30例随访8－40个月。1年后贮尿囊容量360－580ml,贮尿囊内最大压力19．5－78．5cmH2O。白天完全可控28例,可控率93％;夜间完全可控27例,可控率90％。贮尿囊造影及IVU显示单侧输尿管狭窄并肾脏轻度积水1例,无输尿管返流。血清电解质及肾功能正常。结论 去带可控盲结肠膀胱术操作简单,并发症少,疗效可靠,是一种较理想的尿流改道方法。     

去带盲结肠可控膀胱术

目的　改进膀胱癌患者膀胱全切后贮尿和排尿问题。　方法　对 2 3例全膀胱切除患者行去带盲结肠可控膀胱术。　结果　 2 2例术后随访 3～ 30个月 ,3个月后贮尿囊容量 45 0～ 6 0 0ml,平均 5 5 0ml,平均内压 (14± 8)cmH2 O(1cmH2 O =0 .0 98kPa) ,贮尿囊造影未见输尿管返流 ,IVU示上尿路无积水和输尿管狭窄 ,排尿控制良好 ,插管容易。　结论　去带盲结肠可控膀胱术是一种较为理想的尿流改道方法 ,具有较好的应用价值。     

改良Indiana膀胱术的远期疗效观察

目的:评价改良Indiana膀胱术的远期疗效.方法:对26例改良Indiana膀胱术术后患者的膀胱可控性、尿动力学、肾盂输尿管扩张、上尿路感染情况、血清电解质和肾功能进行随访.结果:26例随访1～7年,平均3年.白天可控率96.2%;贮尿囊容量为380～640 ml,平均542 ml;贮尿囊内压力为1.215～3.224 kPa,平均1.921 kPa.B超、IVP造影示3 例输尿管扩张,经随访无加重.血清电解质及肾功能正常.结论:改良Indiana膀胱术远期疗效可靠,并发症少,是一种较理想的尿路分流术式.     

改良可控性盲结肠膀胱术15例报告

目的　提高膀胱肿瘤全膀胱切除的临床疗效。　方法　对 15例膀胱肿瘤患者行可控性盲结肠膀胱术 ,并对术式进行改进。　结果　 15例随访 4～ 2 9个月 ,3个月后贮尿囊容量 45 0～ 6 5 0ml,平均 5 5 0ml,充盈状态下平均囊内压 (11.4± 4.3)cmH2 O(1cmH2 O =0 .0 98kPa) ,贮尿囊造影未见输尿管返流 ,IVU示上尿路无积水和输尿管狭窄 ,排尿控制良好 ,插管容易。　结论　改良可控性盲结肠膀胱术操作简单 ,贮尿囊容量大、内压低、自控排尿良好 ,并发症少 ,具有良好的临床应用价值。     

女性去带盲结肠新膀胱术(附四例报告)

目的 提高女性患者膀胱全切术后生活质量。方法 采用改良根治性膀胱切除加去带盲结肠新膀胱术治疗女性膀胱癌4例。在根治性膀胱切除术中3例采用保护阴道前壁方法，1例采用切除阴道前壁方法。结果 随访6～30个月，4例患者白天均可控制排尿，3例夜间能控制排尿，1例夜间有尿失禁。尿动力学检查显示贮尿囊容量305～438ml，最大囊内压18～45cmH2O(1cmH2O=0．098kPa)，剩余尿量0～30ml，最大尿流率15．1～22．6ml／s。贮尿囊造影及IVu检查未见输尿管返流和输尿管狭窄。血电解质和。肾功能正常。结论 女性膀胱癌患者行改良的根治性膀胱切除去带盲结肠新膀胱术可获得满意的排尿控尿效果。     

阑尾与尿道吻合的回盲肠代膀胱手术远期疗效观察(附11例报告)

目的　评价阑尾与尿道吻合的回盲肠代膀胱手术远期疗效。　方法　应用回盲肠作贮尿囊 ,阑尾代后尿道原位排尿的方法治疗膀胱肿瘤病人 5 6例。　结果　 11例病人术后获 10年以上随访。其中白天完全自控排尿 10例 ,夜间完全自控排尿 8例。伴后尿道假性瓣膜 2例 ,贮尿囊内继发结石 1例 ,后尿道狭窄 1例 ,无输尿管返流 ,无高氯性酸中毒。贮尿囊容量 2 90～ 5 2 0ml,平均 388ml,压力 2 3～ 36cmH2 O(1cmH2 O =0 .0 98kPa) ,平均 2 8cmH2 O。平均尿流率 9.6ml/s。　结论　阑尾与尿道吻合的回盲肠代膀胱术式具有贮尿囊内压低 ,容量大 ,可控性和原位排尿的优点 ,是一种较理想的尿流改道方式。     

原位阑尾作输出道的可控回结肠膀胱术后远期并发症

目的 探讨可控性回结肠膀胱术后远期并发症及其处理方法。方法 膀胱癌患者30例，行回结肠可控膀胱阑尾原位腹壁造口术并进行长期随访观察。随访时间108～126个月，平均118个月。结果 本组远期并发症包括：贮尿囊容量过大5例，贮尿囊内结石形成6例，插管导尿困难4例，输尿管梗阻3例，贮尿囊内出血1例，高氯性酸中毒1例。针对发生的并发症作出相应处理，症状均得到控制。结论 可控性回结肠膀胱阑尾原位腹壁造口术远期疗效可靠，但并发症发生率仍较高，有待进一步完善。     

楔形胃代膀胱术的研究

目的研究楔形胃代膀胱术的适应证、效果及并发症。方法1992年5月至2003年12月，选择膀胱癌全膀胱切除术的病例，行楔形胃代膀胱术6l例，均经尿道排尿。术后随访排尿情况、实验室检查、尿动力学检查、影像学检查、膀胱镜检及了解并发症等。结果61例术后随访5个月～12年，平均6年。排尿通畅者占70．49％(43／61)；排尿间隔2～4．5h，平均3h；尿量280～520ml，平均385ml；最大尿流率13～25ml／s，平均17ml／s；膀胱容量300～550ml，平均375ml；最大尿道压20～60cmH2O，平均48cmH2O；充盈期膀胱压5～14cmH2O，平均11cmH2O；最大膀胱压40～65cmH2O，平均55cmH2O；排尿期最大膀胱压25～60cmH2O，平均45cmH2O。尿道吻合口狭窄者9．84％(6／61)，电切后被纠正。膀胱颈切除术后尿失禁者为100％(12／12)，占总病例的19．67％(12／61)，术后3～6个月尿失禁渐缓解。尿道灼痛伴尿道口溃疡者9．84％(6／61)，均为尿失禁者。无不稳定性膀胱。遗尿者32．65％(16／49)。左输尿管原位与胃膀胱吻合致左肾输尿管积水者为100％(9／9)，左输尿管经骶前腹膜后移至右侧与胃膀胱吻合者无此现象。剩余尿量(1～125ml，平均30ml)81．63％(40／49)。尿潴留者2例。尿路感染者5例，均为排尿不畅者。血尿尿痛症者16．39％(10／61)。酸性尿者100％(61／61)，尿pH4．5～7．0。附睾炎者1例。无幽门括约肌痉挛。术后第12个月发生膀胱颈吻合口肿瘤1例，作肿瘤切除术。术后1～5年内死于肿瘤转移者9例。术后膀胱镜检均见胃膀胱黏膜光滑平整，色泽稍苍白，未见溃疡，1年以上15例取胃膀胱黏膜作光镜及电镜观察。仅见胃膀胱黏膜间质内酸性细胞及淋巴细胞浸润。61例术后血电解质及动脉血气分析均未见明显异常，BUN及Cr值均在正常范围内。结论楔形胃代膀胱术效果好，并发症少。膀胱癌行全膀胱切除，不能保留尿道括约肌者．不宜采用经尿道排尿的原位胃膀胱术。     

部分胃体-窦部代膀胱术的临床应用及长期随访

目的探讨部分胃体-窦部代膀胱术的临床应用价值。方法回顾性分析30例胃代膀胱术患者的临床资料、实验室检查、影像学检查、膀胱镜及尿动力学检查结果。男17例，女13例。年龄21—69岁，平均55岁。原发病为膀胱癌24例，结核性膀胱挛缩6例。结果术后新膀胱贮尿功能良好，患者经尿道排尿，膀胱容量280—580ml，平均385ml；最大尿道压20—60cm H2O，平均49cm H2O；充盈期膀胱压5—15cm H2O，平均12cmH2O；最大膀胱压35—65cm H2O，平均55cmH2O；排尿期最大膀胱压28—60cm H2O，平均46cm H2O；最大尿流率10～28ml／s，平均18ml／s；剩余尿量5～85ml，平均20ml。随访9个月一24年，平均8．2年，无水、电解质代谢紊乱，无输尿管返流，无尿失禁及肾功能损害。4例出现会阴部、膀胱区疼痛；5例出现遗尿，术后3—6个月逐渐缓解；1例因膀胱结石再次手术。术后3．5年膀胱肿瘤复发1例，行经尿道膀胱肿瘤电切术。结论部分胃体一窦部代膀胱术后并发症少，相关生理指标接近正常。     

Management of Late Complications of Continent Urinary Diversion Using the Kock Pouch and the Indiana Pouch Procedures

Background: Continent urinary diversion (CUD) is performed on patients after total cystourethrectomy due to invasive bladder cancer or other diseases requiring urinary diversion. Since 1984, we have performed CUD using either the Kock pouch procedure or a modified Indiana pouch method. During the long-term follow-up, increasing numbers of late complications occurred, especially after the Kock pouch procedure. We summarized the frequency of postoperative complications, their management, and outcome of CUD using these 2 methods. Methods: Between 1984 and 1995, CUD using the Kock pouch method was performed on 102 patients, and on 61 patients using the Indiana pouch method, with a mean follow-up period of 83 and 50 months, respectively. The patients were between 24 and 82 years old, with a mean age of 59 years. In most patients, the Kock pouch was constructed according to the original method, except for the use of a Dacron fabric collar, and the Indiana pouch was made using the ileal patch method. Results: Of 95 patients followed up for more than 3 months after CUD using the Kock pouch method, efferent and afferent nipple valve malfunction occurred in 21 (22%) and 26 (27%) patients, respectively. Efferent complications occurred during the first year after surgery, whereas afferent complications occurred several years after surgery. Open repair surgery (excluding ileus) was necessary for 36 (38%) patients. Of 59 patients followed for more than 3 months after CUD using the Indiana pouch method, 7 patients with stomal stenosis, 2 patients with stomal prolapse, and 1 patient with stricture at the ureterocolonic anastomosis were treated surgically. An hourglass-like deformity of the pouch was seen in 2 patients, on whom the original Indiana pouch method was performed. As a whole, 13 patients (22%) were retreated with open surgery. Urinary calculi occurred in 42 (44%) patients after CUD using the Kock pouch method and in 11 patients (19%) using the Indiana pouch method. The outcome was excellent, good, fair, and poor in 31, 37, 24, and 8% of the patients after CUD using the Kock pouch method, and in 36, 17, 42, and 5% of the patients after CUD using the Indiana pouch method. Conclusions: We performed CUD using either the Kock pouch or the Indiana pouch method with a success rate of approximately 90%. The rates of revision, reoperation and stone formation were higher with the Kock pouch procedure than with the Indiana pouch procedure, while varying degrees of incomplete incontinence and difficulty in catheterization were seen more often in the latter.     

A clinico-physiological comparison of ileal pouch-anal and straight ileoanal anastomoses

The ileal pouch-anal anastomosis improves clinical results after colectomy and mucosal proctectomy compared to the straight ileoanal anastomosis. The question was what physiologic changes brought about by the pouch led to the improvement. Among 124 patients who had had ileoanal anastomosis, 25 volunteered for a detailed clinicophysiologic evaluation. Fourteen had had the ileal pouch-anal operation a mean of 8 months previously, and 11 had the straight ileoanal operation a mean of 25 months previously. Both groups of patients had satisfactory anal sphincter resting pressures (mean +/- SEM, pouch = 68 +/- 8 cm H2O, straight = 65 +/- 9 cm H2O, p greater than 0.05) and neorectal capacities (pouch = 278 +/- 26 ml, straight = 233 +/- 36 ml, p less than 0.05), and all could evacuate spontaneously. However, the pouch patients had a more distensible neorectum (delta V/delta P pouch = 9.5 +/- 1.3 ml/cm H2O, straight = 4.9 +/- 0.9 ml/cm H2O, p less than 0.05) and smaller amplitude neorectal contractions (pouch = 36 +/- 5 cm H2O, straight = 90 +/- 13 cm H2O; p less than 0.05). We concluded that the pouch-anal anastomosis increased the distensibility of the neorectum and decreased its propulsive drive, and so improved clinical results.     

女性原位尿流改道的临床研究

目的　总结女性膀胱全切患者行原位尿流改道的临床疗效。　方法　回顾性分析1995年9月至2003年12月34例女性膀胱全切、原位尿流改道患者的临床资料。34例患者,年龄53~64岁,平均58岁。其中移行细胞癌30例,腺癌3例,鳞状上皮癌1例。原发肿瘤30例,复发肿瘤4例。34例患者均行膀胱全切,其中24例保留自主神经。所有患者均截取末段回肠,行回肠代膀胱。术后随访观察临床效果。　结果　34例手术时间平均360min(280~420min),输血量平均600ml(300~1000ml)。术后30例获随访,随访6~108个月,平均61个月。术后6个月昼夜控尿率分别为90% (27 /30)和86% (26 /30)。一次性排空膀胱23例, 2例排尿可控过度,需定时导尿,另5例需采用手压下腹部排空新膀胱。23例行尿动力检查结果显示:贮尿囊容量300~520ml,充盈期囊内压<23cmH2O(6~23cmH2O, 1cmH2O=0. 098kPa),最大尿道压35 ~70cmH2O,功能性尿道长2. 6~3. 5cm,剩余尿量0~38ml。IVU检查贮尿囊球形,无输尿管狭窄,轻度输尿管返流1例,肾盂输尿管轻度扩张1例。血电解质和肾功能正常.无肠膀胱或尿道残端复发者。　结论　女性膀胱癌患者行原位尿流改道可获得满意的临床效果,可作为该类患者的首选治疗方法。     

阑尾原位脐部造口的可控性回结肠膀胱术

目的尝试根据Ｍｉｔｒｏｆａｎｏｆｆ原理，将阑尾不加任何处理直接从脐孔穿出，构成可控性回结肠膀胱的排出管道。方法 选取末段回肠和肓肠升结肠各约２０ｃｍ，保留阑尾，沿肠系膜对侧缘纵行劈开肠管，远近端对折缝合形成囊袋。双侧输尿管与囊袋以粘膜下隧道法吻合，阑尾末端开放，并直接从脐部戳孔引出固定，形成可控性回结肠膀胱。结果 ８例患者术后随访１０￣３０个月，回结肠膀胱脐部阑尾排出道控尿能力满意，患者自行插管排     

Clinical experience of Kock pouch continent urinary diversion

Kock continent ileal reservoir for urinary diversion was performed in 53 patients with invasive bladder cancer (52) or neurogenic bladder (1). The postoperative follow-up period was from six to thirty-nine months. The clinical results showed no metabolic disturbance of blood electrolytes or acidity. Prolapse of efferent nipple valve developed in 4 patients (7.6%); and 2 underwent revisional surgery with a good result. Another 4 patients (7.6%) suffered from poor continence and relatively frequent catheterization to empty the pouch was necessary to prevent urine leakage through the stoma. Urodynamic study of the Kock pouch in these 4 patients showed a short functional nipple valve length and small pouch capacity. The other 45 patients (84.8%) had good continence. Urodynamic study of the pouch in 20 patients showed low pressure (mean of 13.3 cm H2O) in the pouch and high pressure (mean of 72.1 cm H2O) at the efferent nipple valve. Three patients had unilateral hydronephrosis in the follow-up intravenous urography. Corrective surgery for stenosis at the right ureteroileal anastomosis was done in 1 patient with normalization of the upper urinary tract afterward. The other 2 patients were managed by close observation for the mild hydronephrosis. Symptomatic bacteriuria developed in only 3 patients (5.7%) and responded well to antibiotic management. Reservoirography demonstrated no reflux into the upper urinary tract in all the follow-up patients. There was no significant change of the renal function at twenty-four months after operation detected by radionuclide (131I-Hippuran) renal functional study. All patients were satisfied with Kock urinary diversion.     

Rectodynamic and radiological assessment in modified mainz pouch II cases

OBJECTIVE: To evaluate the radiologic findings and to measure the pressure changes in a modified sigmoidorectal pouch (Mainz pouch II procedure). METHODS: A total of 26 patients who had a radical cystectomy because of muscle-invasive bladder tumor underwent a Mainz pouch II procedure between 1993 and 1998. The differences from the original definition was a reverse ureteral anastomosis and a detubularized segment at least 30 cm in length. In all cases, sigmoidoscopy was done and sigmoidal pressure and capacity were measured preoperatively and at the 3rd and 6th months postoperatively besides the colon X-rays. The 24-hour pouch pressure changes called 'natural pouch pressure' was measured using a handmade system with a central venous pressure (CVP) manometer at the 3rd month postoperatively. RESULTS: Preoperative colon X-rays showed a passage of opaque substance through the descending colon at an average volume of 150 ml (average sigma capacity), whereas postoperative anteroposterior and oblique pouch X-rays showed no passage up to an average volume of 520 ml (270-650) though the descending colon. The sigmoidal colon pressure that was on average 20 cm H(2)O at the preoperative evaluation was measured as 6 cm H(2)O at the 3rd month and 6.5 cm H(2)O at the 6th months during the postoperative period. 24 hour natural pouch pressure was found to be 8.7 cm H(2)O on average while the pressure was found to be 13.8 cm H(2)O on average when the patient felt abdominal discomfort, in other words the desire to defecat (miction). CONCLUSIONS: A modified sigmoidorectal pouch procedure not only provides a reservoir with a higher capacity and lower pressure without a reflux to the upper urinary tract and descending colon with lower metabolic acidosis problem, but it is also a good alternative diversion procedure that whould be preferable especially in Muslim countries as it does not cause any difficulties in terms of Islamic worship.     

Urodynamic findings in patients with a urethral Kock pouch after radical cystectomy]

Urodynamic evaluation was performed in 11 male patients, who underwent radical cystectomy with pelvic lymph node dissection for bladder cancer followed by bladder replacement with a urethral Kock pouch, 3 to 21 months after the operation. Frequency of micturition were 4.9 +/- 1.5 times (mean +/- S.D.) during the day-time and 1.5 +/- 1.2 times during the night-time. Tidal volume of micturition ranged from 300 to 550 ml and residual volume from 10 to 30 ml. Urinary continence was completely preserved in all patients (100%) during the day-time and 8 (72.7%) during the night-time. On pouchmetry, maximum capacity of the pouch was 429.2 +/- 82.4 ml, and intra-pouch pressure was 16.2 +/- 5.4 cmH2O at the capacity of 200 ml and 38.7 +/- 11.5 cmH2O at the maximum capacity. Maximum intra-pouch pressure on voiding was 80.0 +/- 19.4 cmH2O. Uroflowmetry demonstrated intermittent voiding curves in all the patients, with maximum flow rate of 15.2 +/- 6.5 ml/sec, voided volume of 405.9 +/- 80.7 ml and residual rate of 4.5 +/- 2.6%. Maximum intra-urethral pressure at the external urethral sphincter was 28.0 +/- 11.3 cmH2O when the pouch was empty and increased in response to pouch filling up to 64.7 +/- 27.0 cmH2O. Maximum urethral closing pressure and total profile length on the urethral pressure profile were 30.2 +/- 12.4 cmH2O and 20.9 +/- 9.0 mm, respectively, with the pouch empty, and 23.2 +/- 14.5 cmH2O and 20.0 +/- 7.6 mm, respectively, with the pouch full.(ABSTRACT TRUNCATED AT 250 WORDS)