输尿管皮肤造口患者经济毒性状况及影响因素分析

目的 了解膀胱癌输尿管皮肤造口患者经济毒性现状并分析其影响因素,为探索干预策略提供参考。方法 采用便利抽样法抽取就诊于伤口造口门诊的130例输尿管皮肤造口患者,采用一般资料调查表、患者报告结局的经济毒性综合评分量表、恐惧疾病进展简化量表、患者健康问卷抑郁量表进行调查。结果 输尿管皮肤造口患者经济毒性发生率为86.15%,经济毒性总分为23.00(17.00,25.00)分;相关性分析结果显示,恐惧疾病进展水平、抑郁水平与经济毒性呈正相关(均P<0.01);多元线性回归结果显示,恐惧疾病进展、抑郁、年龄、家庭人均月收入、医保类型、到达医疗机构的乘车时间是患者经济毒性的影响因素(P<0.05,P<0.01)。结论 输尿管皮肤造口患者经济毒性阳性率较高,在临床工作中应特别关注年轻、低收入、未参保、到达医疗机构的乘车时间较长的输尿管皮肤造口患者经济毒性的评估,对高危患者进行早期干预,防止因经济毒性引起不良结局事件。     

Terminal loop cutaneous ureterostomy in renal transplantation: an under utilized urinary diversion technique

PURPOSE: We evaluated the effectiveness of terminal loop cutaneous ureterostomy as a means of urinary drainage in kidney transplant recipients during a 20-year period. MATERIALS AND METHODS: Five cadaveric and 2 living related patients underwent kidney transplantation with terminal loop cutaneous ureterostomy between 1984 and 2004. These patients had no usable bladder or they were not suitable candidates for intermittent catheterization. RESULTS: Followup was 20 months to 17 years. One patient underwent stomal revision 5 months after renal transplantation. Current serum creatinine 4 years later was 166 mumol/l. The remaining 6 patients had no evidence of ureteral obstruction and rarely had bacteriuria or urinary tract infections. Four patients had a functioning allograft with normal serum creatinine. One patient died with a normally functioning allograft and the remaining patient lost his graft due to chronic rejection. No patient in this series lost the graft due to a urological cause. Overall outcomes included excellent allograft function with minimal infection or stomal stenotic complications. CONCLUSIONS: Terminal loop cutaneous ureterostomy is a simple, safe and alternative means of urinary diversion in patients with renal transplant and a defunctionalized lower urinary tract.     

1例双侧输尿管皮肤造瘘伴重度伤口感染患者的护理石慧*,朱卫青,王银云

伤口邻近处开设造口容易出现尿液渗漏而引起伤口感染,如同时伴有造口位置不佳,则大大增加尿液渗漏和伤口感染的可能性,护理难度大。通过对1例双侧输尿管皮肤造瘘术后合并造口周围伤口感染患者的护理,对感染伤口扩创引流,清除坏死组织,采用安普贴封闭保护伤口;同时,通过选用适合位于不平坦位置的柔软小底盘造口用品,妥贴裁剪,有效收集尿液,避免尿液外渗,使伤口顺利愈合,取得满意的护理效果。     

Laparoscopic transureteroureterostomy: a novel approach

PURPOSE: We describe the feasibility and short-term results of laparoscopic transureteroureterostomy in children. MATERIALS AND METHODS: We performed transperitoneal laparoscopic transureteroureterostomy with a 4-trocar technique in 3 children with a mean age of 63 months (range 18 to 105). Diagnoses were unilateral ureteral obstruction after cross-trigonal reimplantation for vesicoureteral reflux (1 patient), unilateral refluxing megaureter (1) and ureteral injury after bladder diverticulectomy (1). Cystoscopy, retrograde pyelogram and stent placement in the recipient ureter were performed at the beginning of each case. The anastomoses were carried out with running 6-zero reabsorbable sutures at the level of the pelvic bream. An abdominal drain and Foley catheter were left indwelling for 1 to 3 days. RESULTS: All cases were performed successfully. Postoperative course was uneventful except for a transient urinary leak, and patients were discharged home on postoperative day 2 to 4. At a mean followup of 6 months all patients were clinically well, with normal kidney function and blood pressure, and no significant hydronephrosis. CONCLUSIONS: Based on our initial experience, laparoscopic transureteroureterostomy is safe and effective, and is associated with little blood loss, minimal analgesia requirements, fast recovery and excellent cosmetic results. We believe that in selected cases in which transureteroureterostomy is the chosen technique a laparoscopic approach is advantageous.     

腹腔镜根治性膀胱癌切除术后行回肠膀胱术和输尿管皮肤造口术的疗效比较

目的 比较腹腔镜根治性膀胱癌切除术后行回肠膀胱术和输尿管皮肤造口术的疗效.方法 选择行腹腔镜根治性膀胱癌切除术后患者90例,随机分为A组和B组,均45例.A组采取回肠膀胱术,B组采取输尿管皮肤造口术.比较2组手术时间、术中出血量以及术后住院时间、术后并发症、术后生存质量.观察2组患者的胃肠道功能恢复情况.结果 B组患者的手术时间、术中出血量及术后住院时间均明显低于A组(P＜0.01).2组术后尿路感染和肺感染的发生率差异无统计学意义(P＞0.05),B组的切口感染、肠梗阻发生率均明显低于A组,而漏尿发生率明显高于A组(P＜0.05).2组患者术后生理状况、社会/家庭状况、情感状况、功能状况评分比较无统计学差异(P＞0.05).B组胃肠功能恢复的优良率为44.44％,显著高于A组22.22％,差异有统计学意义(x2 =4.05,P＜0.05).结论 膀胱癌切除术后回肠膀胱术和输尿管皮肤造口术各有优、缺点,可根据患者个体情况选择合适的手术方式.     

膀胱癌两种不同尿流改道术后生活质量分析

目的:观察膀胱癌患者行根治性膀胱切除输尿管皮肤造口术、回肠膀胱术两种改道方式术后生活质量。方法:采用膀胱癌特异性量表FACT-BL对在我院接受根治性膀胱切除输尿管皮肤造口术和回肠膀胱术的术后生活质量进行调查。结果:根治性膀胱切除输尿管皮肤造口术、回肠膀胱术术后总体生活质量无明显差别（P＞0.05）。结论:根治性膀胱切除输尿管皮肤造口术、回肠膀胱术均为泌尿外科常用术式,在临床上,应充分向患者说明各种术式利弊,结合患者自身情况,选择合适术式,以提高患者生存质量。     

膀胱癌输尿管皮肤造口患者自我隐瞒现状及影响因素分析

目的了解膀胱癌输尿管皮肤造口患者自我隐瞒现状并分析其影响因素,为针对性干预提供参考。方法对184例膀胱癌输尿管皮肤造口患者采用一般资料调查表、自我隐瞒量表、事件相关反刍性沉思问卷、社会影响量表进行调查,分析影响因素。结果患者自我隐瞒得分30.97±6.27;与侵入性反刍性沉思呈正相关,与目的性反刍性沉思呈负相关,与病耻感呈正相关(均P<0.01);多元线性回归分析显示,病耻感水平、反刍性沉思水平、文化程度、年龄、造口接受程度是患者自我隐瞒倾向的影响因素(调整R 2=0.589;P<0.05,P<0.01)。结论膀胱癌输尿管皮肤造口患者自我隐瞒倾向处于中等水平,受多种因素的影响;护理人员应针对影响因素实施个体化干预措施,以降低其自我隐瞒倾向。     

Percutaneous ureterostomy as an effective diversion in a newborn

Ectopic ureter in a duplicated system in men is rare and rarely causes bilateral obstructive symptoms. The tendency of the ureter to dilate more than the caliceal system is unique to neonates and makes upper urinary diversions more challenging. However, alternative percutaneous diversions other than nephrostomy might be beared in mind in such cases with huge dilatation in ureters in suffering neonates. As discussed in this case percutaneous ureterostomy may be very effective and have a role in diagnosis and management of neonatal hydroureteronephrosis.     

Modified technique for improving tubeless cutaneous ureterostomy by Ariyoshi method

Objectives:   The cutaneous ureterostomy is the simplest urinary diversion method; however, it often causes stomal stenosis, requiring sustained catheterization with regular catheter exchange. In an attempt to prevent stomal stenosis after surgery, the fascia (S-U fascia) between the spermatic cords and the ureters, which is usually cut off, was preserved. The remaining capillaries in the fascia could supply blood to the ureters, which is one of the most important factors for ureter patency.
Methods:   In 58 patients (93 renal units) undergoing cutaneous ureterostomy, 36 patients (66 renal units) were treated by the modified technique.
Results:   The surgeries carried out with the modified technique were significantly different in the type of operation, the side relationship, and the catheter-free rate using the univariate analysis by means of the predicted tests, in comparison with 22 patients (27 renal units) that were treated with the conventional technique. Multivariate analysis for the type of operation determined that of the side relationship and the method, only the latter was a significant factor. The modified method allowed ∼90% of the patients to have a catheter-free life; otherwise 74% of the patients had stomal stenosis, followed by catheterization.
Conclusion:   The presented cutaneous ureterostomy technique to preserve the fascia is useful not only to prevent stomal stenosis and maintaining good quality of life without catheterization, but also to apply to other types of ureter surgery.