腹腔镜膀胱憩室切除术的手术配合

泌尿外科腹腔镜从单纯应用于疾病诊断已发展为用于多种疾病治疗的手段。在膀胱憩室的治疗中，腹腔镜手术有切口小、术中损伤小、术后排尿功能恢复快等优点。我院于2006年8月完成1例，效果满意。现将手术配合进行总结，报道如下。[第一段]     

膀胱憩室癌5例报告

目的：探讨膀胱憩室癌的临床特征，提高其诊治水平。方法：对5例膀胱憩室癌患者均行CT和膀胱镜检查确诊。3例行根治性膀胱全切、尿流改道手术．2例行膀胱部分切除术。结果：病理诊断移行细胞癌2例，鳞状细胞癌2例，恶性神经鞘瘤1例。3例于术后2个月内死亡，均为非移行性细胞癌；另外2例术后随访10个月，无局部复发和远处转移。结论：CT和膀胱镜检查是确诊膀胱憩室癌的重要方法；膀胱憩室癌的临床分期不同，预后明显不同，非移行细胞癌病理类型有早期浸润行为．预后差。     

膀胱憩室小细胞癌1例

患者,男,84岁。因间歇无痛性肉眼全程血尿3个月,加重伴乏力,尿痛1周,于2009年6月14日入院。患者3个月前出现肉眼血尿,为全程无痛性,1周前上述症状加重,伴乏力,尿痛,无发热、盗汗、消瘦及腰腹部疼痛。患者既往排尿困难7年,未系统治疗。体检：耻骨上区偏左可触及约8cm×9cm囊性包块,光滑,压痛不明显。肛门指诊前列腺Ⅱ度大,质韧,未触及质硬结节,中央沟消失。     

腹腔镜膀胱部分切除术治疗膀胱憩室和良性肿瘤的探讨

目的：探讨腹腔镜膀胱部分切除术治疗膀胱憩室、膀胱良性肿瘤的可行性和应用效果。方法：采用经腹腔途径行腹腔镜膀胱部分切除术治疗3例膀胱憩室和1例膀胱副神经节瘤患者,手术操作包括膀胱部分切除和完全的腔内膀胱缝合。结果：4例手术均获得成功,平均手术时间80（60～120）min,术中平均出血76（40～100）ml,术中、术后无明显并发症,平均术后住院5（3～7）天。结论：采用腹腔镜膀胱部分切除术治疗膀胱憩室和良性肿瘤是安全、可行的方法,具有微创、恢复快、住院时间短等优点,是治疗膀胱憩室和良性肿瘤的可选择的手术方法之一。     

膀胱憩室疝1例

患者　男 ,34岁。因左侧腹股沟包块 2年入院。体查 :左腹股沟部有一约核桃大小包块 ,无疼痛 ,不能还纳。诊断 :左侧腹股沟斜疝。拟行疝高位结扎修补术。当显露“疝囊”时 ,切开后有黄色液体流出。用手指探查 ,发现其与膀胱相通 ,经探查证实疝内容物为膀胱憩室。切除憩室 ,缝合修补膀胱后行疝修补术。术后留置尿管 5ｄ ,痊愈出院。膀胱憩室疝1例@杨兴勇$四川省康定县姑咱人民医院外科!四川康定626001膀胱憩室疝;;病例报告     

小儿先天性膀胱憩室

目的 总结先天性膀胱憩室患儿的诊疗特点.方法 回顾性分析22例先天性膀胱憩室患儿的临床资料.均为男童,年龄7 d～12岁,平均3.5岁.临床表现排尿困难、尿潴留、反复尿路感染等症状,均经排尿性膀胱尿道造影检查确诊.18例25根输尿管合并膀胱输尿管反流,术前18例行IVU检查,上尿路正常7例,上尿路扩张积水10例,右肾发育不良1例.结果 22例均行憩室切除、膀胱修复术,合并膀胱输尿管反流者同期行输尿管膀胱再吻合术.17例随访6个月～11年,平均4.5年,患儿临床症状均消失,憩室无复发.14例原膀胱输尿管反流者,反流消失12例,1例有Ⅰ度反流者,保守治疗半年反流消失,1例仍有双侧膀胱输尿管反流,行膀胱造瘘术后半年,目前仍在随访中.IVU复查12例,上尿路积水好转7例,积水无变化3例,2例左肾不显影者术后仍不显影.结论 小儿先天性膀胱憩室较少见,但可引起上尿路严重损害甚至危及生命,早期诊断、早期合理治疗是提高疗效的关键.     

膀胱憩室癌11例诊治体会

报告膀胱憩室癌11例,并就其临床症状、诊断及治疗等进行讨论,认为如病人发生血尿合并下尿路梗阻、尿频、脓尿、二次排尿等症状时,应高度怀疑本病;诊断首选膀胱镜检查,B超、CT对肿瘤分期具有重要意义;治疗以膀胱部分切除为主,因憩室癌恶性程度高、预后差,术后应辅以放疗或化疗。     

CT逆行性膀胱造影诊断膀胱憩室

目的探讨CT逆行性膀胱造影诊断膀胱憩室的价值。方法分析7例经手术证实的膀胱憩室患者的影像及临床资料。结果 7例患者均接受CT平扫,2例获得明确诊断。对3例行增强CT扫描,明确诊断2例。4例接受CT逆行性膀胱造影,均获明确诊断。同期对3例行超声检查,明确诊断1例;对4例行膀胱X线造影,明确诊断2例。结论 CT逆行性膀胱造影能准确诊断膀胱憩室,较好地显示膀胱憩室的大小、部位、形态、开口,是诊断膀胱憩室简便有效、经济的检查方法。     

腹腔镜经腹膜外腔膀胱憩室切除术(附2例报告)

目的:探讨腹腔镜下经腹膜外腔行膀胱憩室切除术的可行性。方法:2例女性膀胱憩室患者,采用腹腔镜下耻骨后腹膜外膀胱憩室切除术,腹腔镜手术前首先用电切镜在憩室颈电凝一周以作为腹腔镜切除膀胱憩室时的界限;利用输尿管镜将F18Foley尿管置入膀胱憩室内,气囊注水,以便术中辨认憩室的位置。结果:2例患者手术皆顺利,术中出血分别约50、30ml,手术时间分别为150、120min。术后第一天即下地活动并恢复饮食,第7天行膀胱造影证实憩室已彻底切除且无尿漏后拔除尿管。术后随访时间分别为12个月及6个月,症状均无复发。结论:腹腔镜下经耻骨后腹膜外腔行膀胱憩室切除术是一种安全、可行的手术方法,手术创伤小,患者恢复快。憩室内放置气囊尿管有利于腹腔镜下辨认憩室,而憩室颈口的电凝提高了手术切除的精确性。     

巨大膀胱憩室癌并多发结石1例

膀胱憩室癌国内报道不多，而巨大膀胱憩室癌伴多发结石更少见。我院近期收治1例，报告如下。     

Vesical prolapse in an apparently "normal" bladder

Bladder prolapse is extremely rare in children. Reports have been limited to pathologic bladder conditions such as the exstrophy-epispadias complex. We report an interesting presentation of bladder prolapse in a child with Williams syndrome with an apparently normal bladder.     

Congenital Vesical Diverticulum in a 38-year-old Female

A 38-year-old female with a history of psychiatric illness presents with irritative urological symptoms and is diagnosed as having a large congenital vesical diverticulum (Hutch diverticulum). An overview of the aetiology, classification and complications of diverticula together with indications for and management of bladder diverticula is discussed. This is the first documented case of a very large symptomatic congenital diverticulum in a female presenting in the third decade of life and emphasizes the importance of ultrasound in irritative urological symptoms resistant to medication.     

Surgical management of primary bladder diverticula in children

Purpose

The aim of this study was to review the authors' surgical experience with primary bladder diverticula in the pediatric population, with special attention to associated urinary tract infections and voiding dysfunction.

Methods

A retrospective review yielded 21 pediatric patients with primary bladder diverticula treated surgically over a 13-year span. Patients with secondary diverticula were excluded. Charts were reviewed and patients were contacted in regards to several factors. Diverticula were diagnosed preoperatively by radiography on a voiding cystourethrogram. Diverticula, which were only found intraoperatively and not on VCUG, were not included in the study.

Results

Mean age at presentation was 8.16 years (range of 0.17-12.91 years). The sex predominance was male, 17 (81%) of 21. Mean follow-up was 44.2 months (range of 6-156 months). The diverticula were associated with ureters requiring reimplantation in 15 of 21 patients (72.4%); only 6 (28.6%) of 21 were isolated diverticula. Nineteen (90.5%) of 21 patients presented with infections, and all 19 (100%) have had complete resolution of infections. Of the total, a subset of 6 patients with isolated diverticula and no evidence of reflux had total resolution of their infections. Twelve patients presented with voiding dysfunction. Eight of these 12 patients had improvement of their voiding dysfunction with complete resolution in 2 patients.

Conclusions

In this series, infections were eliminated with surgical excision of the primary diverticula. Surgical repair was also associated with improvement of voiding dysfunction.     

The Results of Operative Teatment for Recurrent Dislocation of the Gleno-Humeral Joint

Thirty-eight patients with a fracture of the posterior wall of the acetabulum were reviewed after 5 (2-12) years. Of 18 patients with successfull manuel reduction of a femoral head dislocation, a small fracture fragment, no sciatic nerve injury and who were not operated on, 17 had a good result. Of 20 patients who were operated on either because of the large size of the fracture fragment or because of a persistent dislocation of the femoral head, 6 had a poor result due to femoral head necrosis. In these 6 patients the reduction had been delayed and the acetabular osteochondral lesion was more severe than in the other patients. Skeletal traction seems unnecessary in the treatment of acetabular posterior wall fracture.     

Vesical varices and telangiectasias in a patient with ataxia telangiectasia

A Japanese boy with ataxia telangiectasia (AT) developed severe gross hematuria and recurrent bladder tamponade, requiring an extensive blood transfusion. He had received intermittent intravenous cyclophosphamide pulse therapy (cumulative dose of 1.3 g) for refractory steroid-resistant and intravenous immunoglobulin-resistant severe autoimmune thrombocytopenia 3 years previously. A cystoscopy revealed multiple varices and severe telangiectasias in the bladder wall. The intensive treatment, such as repeatedly selective embolization of the vesical arteries, proved to be partially effective. Finally, a surgical cystotomy resulted in a gradual improvement in clinical symptoms. To the best of our knowledge, this is the first report of a patient with AT who developed refractory bladder hemorrhage caused by widespread vesical telangiectasias.     

膀胱热灌注化疗与普通膀胱灌注化疗患者的生命质量比较

目的 比较膀胱热灌注化疗与普通膀胱灌注化疗患者的生命质量.方法 采用欧洲癌症研究与治疗组织生命质量核心量表EORTC QLQ-C30 V3.0及非肌层浸润性膀胱癌(NMIBC)患者生命质量特异性模块QLQ-NMIBC 24,分别于膀胱肿瘤电切术(TURBT)前与膀胱诱导灌注治疗后评价2组共132例中高危NMIBC患者的...     

双氯灭痛直肠给药治疗下尿路术后并发的膀胱无抑制性收缩

对３０例下尿路术后并发的膀胱无抑制性收缩患者按随机化顺序，采用单盲交替给药法，分别用自制双氯灭痛胶浆剂１００ｍｇ直肠给药和异搏定１０ｍｇ静注进行治疗。症状改善后复发或未改善者２小时后交叉用药。结果显示：双氯灭痛治疗总有效率为８８．５％，异搏定总有效率７５％，两者比较差异无显著性（ｐ＞０．０５），但双氯灭痛显效率和作用持续时间明显优于异搏定（Ｐ＜０．０５，Ｐ＜０，００１），且无明显副作用。因此认为双氯灭痛是一种治疗膀胱无抑制性收缩的较理想用药。