阑尾原位经脐造口的可控性回结肠膀胱术(附32例报告)

目的 探讨无处理阑尾脐部造口可控性回结肠膀胱术的临床效果。方法 回、结肠各约２０ｃｍ,纵形剖开、拼接形成囊袋。采用未经处理的阑尾由脐部直接引出造口。共为３１例膀胱肿瘤和１例间质性膀胱炎患者实施了膀胱全切、无处理阑尾经脐造口的可控性回结肠膀胱术。结果 新膀胱容量３００～５００ｍｌ,内压达４０ｃｍＨ２Ｏ无尿溢出。患者可自我导尿,造口勿需覆盖,不影响任何活动。随访６个月至５年,临床效果满意。结论 无处理     

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     

可控性回结肠膀胱术远期疗效的临床研究

目的 对可控性回结肠膀胱术的远期疗效进行评价。方法 对23例回结肠膀胱术术后患者的可控性尿动力学、血清电解质、肾功能等进行随访观察。结果 23例随访4～126个月，平均59个月。白天可控率为100％，夜问可控率96％。贮尿囊容量350～640ml，平均560ml，贮尿囊内压力9．30～32，08cmH2O（1cmH2O=0．098kPa），平均19．20cmH2O。B超、静脉肾盂造影（IVP）及贮尿囊造影显示：单侧输尿管狭窄并肾积水1例。贮尿囊结石2例。血清电解质及肾功能正常。结论 可控性回结肠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。     

可控性回结肠膀胱术

自１９９３年６月到今，我们参考Ｌｏｃｈ ｈａｒｔ和杨氏术行控性回结肠膀胱术９例，术后全部得到随访。自己插管导尿顺利，容量大多为３００－４００ｍｌ，回壁造瘘口无溢尿。本文介绍了手术方法和本术式的优点，探讨了全膀胱和切除的手术和围手术期应注意的问题。     

改良低压可控性回结肠膀胱术

目的 建立一种更接近生理的回结肠代膀胱术。方法 1991年10月至1996年10月实施8例全膀胱切除回结肠膀胱与尿道吻合,由外括约肌控制,经尿道排尿的新手术方法。结果 术后随访8个月～9年8个月,平均5年3个月。至随访日全部无吻合口狭窄,排尿通畅,无肾盂积水,肾功能正常。结论 该术式具有贮尿囊内压低(12～20 cmH_2O)、容量适中(300～460 ml,一年后400～700 ml)、可控性和原位排尿的优点,操作简单、并发症少,且无电解质紊乱和肾功能损害,是一种较好的尿流改道方式。     

可控性回盲结肠代膀胱术10例报告

报告１９９２年５月～１９９６年７月施行可控性回盲结肠代膀胱术１０例，随访４个月～４年６个月，除１例无尿毒症外，９例健在，均恢复正常社交活动甚至劳动，患者对可控性回盲结肠膀胱均满意，无一例出现输尿管返流及尿失禁，表明该术式具有可靠的抗输尿管返流，抗尿失禁的作用，有贮尿囊容量大，内压低，插管导尿管顺利等优点，完全满足患者生活方便的要求。     

可控性回结肠膀胱术10例报告

对１０例膀胱癌患者施行根治性全膀胱切除可控性回肠膀胱术，经随访，除１例术后２年因肿瘤转移至盆腔骨关节及肺部而死上，９例均健在，可控自行导尿，无漏尿及返流现象，结果表明，这种用结肠去管重建，用缩窄的末段回肠做输出道的贮尿囊，可控性能好，容量大，电解质紊乱轻，插管容易，不影响肾功能，并发症少，临床观察效果满意。     

结肠造口还纳手术时机及术式的探讨

目的 探讨结肠造口术后还纳术的手术时机、术式及技巧。方法 对1989～2000年8月38例结肠造口还纳术病例进行回顾性分析。结果 单纯袢式造口还纳手术16例,肠切除吻合术22例,平均手术时间2.1 h,并发症发生率10.5％,无死亡。结论 造瘘口还纳手术时机应个体化,术前充分准备、合理选择术式是降低并发症及病死率的关键。     

Transcutaneous implant evacuation system: a new approach to continent stoma construction

Aim Several attempts have been made to construct a mechanical continent stoma without success. A system based on a titanium implant has been developed in an animal model. Following evaluation of this device in animals, the transcutaneous implant evacuation system (TIES) has now been tested in humans. Method The implant consists of a titanium cylinder including a mesh and a plastic cap. This design allows the intestine and subcutaneous tissue to grow into the device. Four patients with inflammatory bowel disease underwent surgery. The indications for surgery were malfunctioning pouches or skin problems around the stoma. Following abdominal surgery, implantation of the device was made behind the external fascia with diversion of the ileum through the device to create a permanent stoma. Results Primary surgery was uncomplicated. Skin tissue growth into the implant was delayed in one case and one patient had impaired healing between intestine and the device. In these cases minor surgical correction was necessary. The tested cap design in the current device was inconvenient and needs to be further developed. No local infections occurred. Conclusion This first clinical study of the TIES device has shown few device‐related complications and no significant safety concerns. In our experience bridging of connective tissue between the intestine and skin is crucial for healing. Further development of the lid, the implant and the implantation method within clinical trials is necessary before the device can be introduced in general practice.     

低压可控性回肠代膀胱术17例报告

目的：探讨膀胱全切除术后患者理想的膀胱替代式。方法：采用Ｗ形尿囊及球形贮尿囊代膀胱作低压可控性回长膀胱术治疗因膀胱癌而行膀胱全切除术患者１７例。结果：随访０．５￣２年,经代膀胱造影、测压和ＩＶＵ检查,效果满意,仅５例术后出现没的并发症,经症处理均治愈;术后膀胱容量达２４０￣５６０ｍｌ,膀胱静压为２．４４￣４．６８ｋＰａ。结论：本文式代膀胱内压低、容量大、抗反流效果好无明显输尿管梗阻及肾盂积水,无     

Clinical experience of tapered distal ileum for construction of a continent colonic urinary reservoir

Construction of continent colonic urinary reservoir was performed in 44 patients after exenteration for invasive bladder carcinoma or various gynecologic tumors. The distal ileum was tapered over a 14 French red rubber catheter. The ileocecal valve was reinforced with three circumferential silk sutures in a purse-string fashion. Full continence was obtained in all patients (100%). A non-tunneled, non-refluxing ureterocolonic anastomosis was performed in all 88 ureters. No obstruction or reflux was observed in 84 ureters (95%). There were 7 early postoperative complications and 3 of them required reoperation (pelvic abscess 1, urinary leak from ureterocolonic anastomosis 1, pouch-vaginal fistula 1). Moreover, there were 7 late complications and 3 of them required reoperation (stomal stenosis 1, parastomal hernia 2). These results suggest that this method is a safe, simple and useful one for permanent urinary diversion.     

去带盲升结肠可控膀胱术后贮尿囊结石

目的:探讨去带盲升结肠可控膀胱术后贮尿囊结石的发生原因与对应措施.方法:对去带盲升结肠可控膀胱术后患者105例随访14～94个月,平均43.5个月,对相关临床资料进行回顾性分析.结果:贮尿囊结石发生率6.7%(7/105),6例手术治愈,其中2例行经皮穿刺膀胱镜下气压导弹道碎石,4例行贮尿囊切开取石,术后随访未见复发.结论:去带盲升结肠可控膀胱术后贮尿囊结石的发生多与症状性泌尿系感染相关,规律、充分的贮尿囊冲洗及定时清洁导尿对于预防贮尿囊结石有重要作用;选择性地采取经皮穿刺膀胱镜下碎石术或贮尿囊切开取石术,均可取得理想治疗效果.     

The Hadera continent reservoir: a new appendico-umbilical continent stoma mechanism for urinary diversion

PURPOSE: Creating a reliable continence mechanism for a continent reservoir is a great challenge. We describe an easily formed mechanism for allowing complete continence in such patients. MATERIALS AND METHODS: The native appendix attached to a detubularized right colonic reservoir was used as the catheterizable efferent limb. The continence mechanism was created by crossing 2 nondetached right rectus muscle strips around the appendix. RESULTS: At a mean followup of 32 months (range 4 to 52) in 17 patients complete continence was obtained between 2 to 4-hour self-catheterizations in all positions and even during straining. CONCLUSIONS: This continence mechanism is easy to construct and creates a reliable continent stoma in all patients who are not candidates for orthotopic bladder replacement and who retain the native appendix. In patients who have undergone appendectomy an alternate method is to create a small caliber efferent limb from a tailored terminal ileum and build the continence mechanism around it.     

Stapled and nonstapled tapered distal ileum for construction of a continent colonic urinary reservoir

A continent colonic urinary reservoir was created in 10 patients who had undergone anterior exenteration for invasive bladder carcinoma. A tapered distal ileal segment with a catheterizable abdominal stoma provided full continence in all 10 patients. Tapering of the terminal ileum was achieved with a gastrointestinal anastomosis stapler in 5 patients or with a bowel clamp in 5 others. Three purse-string sutures of 2-zero silk were placed on the tapered ileal segment to increase the intraluminal pressure. A nontunneled ureterocolonic anastomosis was performed in all 20 ureters. No obstruction or reflux was noted in 19 ureters (95 per cent). Hydronephrosis at the anastomotic site was noted in 1 ureter and was successfully dilated percutaneously.     

带蒂腹直肌瓣包绕缩窄回肠输出道增强控尿机制的实验研究

目的 改良可控输出道术式,增强可控输出道的长期控尿能力.方法 1～2岁杂种犬10只,雄性2只,雌性8只.分别截取30～40 cm末端回肠U形折叠制成储尿囊,另取2段6 cm回肠段缩窄为可通过12 F导管的输出通道.切取6 cm×3 em腹直肌,保留神经m管束,自1条缩窄同肠输出道的肠系膜血管间穿过,包绕十输出道外作为控制管;另1条输出道直接连接腹壁皮肤作为对照管.术后1、3、6个月分别测定储尿囊空虚和充盈时输出道压力(MIP)及功能性压力段长度(FPL).分析储尿囊充盈前后控制管与对照管MIP与FPL的差异.结果 1条犬术后6个月储尿囊允盈中液体经对照管溢出,无法完成实验.其余9条均行3次测压.储尿囊充盈前后,控制管MIP均70 cm H2O(1 cm H2O=0.098 kPa);对照管分别为<30、40<45 am H2O,均明显低于控制管.术后1、3、6个月,储尿囊充盈前后,控制管MIP平均值分别为(73.51±24.01)与(77.68±25.15)、(71.16±19.35)与(79.78±21.25)、(70.28±18.30)与(75.93±17.53)cm H2O,FPL平均值分别为(4.78±0.78)与(4.60±0.75),(4.71±0.61)与(4.61±0.54)、(4.49±0.65)与(4.24±0.97)cm,充盈前后差异均无统计学意义(P0.05);对照管MIP平均值分别为(29.04±7.02)与(42.90±7.66)、(28.10±8.09)与(41.63±8.98)、(26.63±6.89)与(43.36±9.79)cm H2O,FPL平均值分别为(5.04±0.44)与(4.59±0.53)、(4.98±0.82)与(4.42±0.85)、(4.63±0.69)与(3.97±0.53)cm,充盈前后差异均有统计学意义(P<0.05).术后6个月造影显示输出管与对照管形态无明显差异,无扭曲、狭窄或瘘道形成;组织学检查可见控制管回肠浆膜层外明显横纹肌组织结构.结论 带带腹直肌肌瓣翻转包绕输出道可有效提高输出道的控尿能力,凡有利于同定输出道,方便插管.     

Construction of a stable nipple valve with processed dermal sheep collagen for continent ileostomy and urostomy

Summary Complications of the nipple valve system used for continent urostomy and ileostomy basically consist of incomplete (or complete lack of) adhesion of the invaginated serosal surfaces of the valve. A novel concept in fixation of the valve by means of the intussusception of a newly developed biomaterial (processed dermal sheep collagen; PDSC) was tested. The implanted PDSC is characterized by induction of fibroblast invasion and formation of new collagen fibers, initial high tensile strength, bio-inertion and (slow) biodegradation. It was implanted between the serosal surfaces of the invagination in 14 dogs without the application of the commonly used staples and synthetic mesh. Good permanent fixation was obtained in all cases after the PDSC had been sutured in place. As the observation time advanced up to 2 years, an increased amount of newly formed collagen was seen anchoring the serosal surfaces firmly together via the implanted PDSC with apparent slow degradation. In none of the test animals did complications accur. The first clinical trial was successful.This study was sponsored by the Preventie fonds     

膀胱全切术后原位回盲肠膀胱与可控盲结肠膀胱患者远期生活质量比较

目的：比较原位回盲肠膀胱（原位组）与可控盲结肠膀胱两种膀胱重建术（可控组）患者的远期生活质量,探讨新膀胱重建的最佳选择方式。方法：以随机问卷方法,对原位组25例和可控组29例男性患者,于术后平均6个月进行生活质量比较。结果：两组问卷回收率分别为92％与90％。原位组23例术后6～40个月（平均26个月）,可控组26例术后12～40个月（平均28个月）问卷回收。性生活正常分别为21例、21例,肾功正常分别22例、23例,控尿情况（尿失禁一般）分别6例、1例（P〈0．05）。生活情绪一般分别为20例、24例,日常行为无影响分别为22例、22例,并发症（结石、尿漏、血电解质）分别3例结石和血电解质紊乱3例与1例结石（均恢复）（P〈0．05）。结论：二者在性生活、肾功、生活情绪无明显差异,但在控尿及术后并发症方面有明显差异,可控盲结肠膀胱较原位回肠膀胱尿控要好。