改良乙状结肠直肠膀胱术12例治疗体会

当膀胱癌已侵犯膀胱颈及后尿道时 ,为寻找合适的尿流改道方法 ,1990年以来 ,我们对 12例患者施行了改良乙状结肠直肠膀胱术 ,效果满意。治疗体会报告如下。1　临床资料1.1　一般资料本组 12例 ,男 8例 ,女 4例 ;年龄 38～ 6 9岁 ,平均 5 4.6岁。其中多发性膀胱癌 10例 ,膀胱三角区巨大肿瘤 2例 ,均已侵犯膀胱颈及后尿道 ,其中 4例为膀胱复发肿瘤 ,2例行膀胱部分切除术 ,2例行腔内电切术。除 1例年轻女性为腺癌外 ,其余均为移行上皮细胞癌 (Ⅱ～Ⅲ级 )。术前通过肛诊 ,灌肠试验判断肛门括约肌功能正常 ,钡剂灌肠或乙状肠镜检查排除直肠乙状结…     

乙状结肠癌并发结肠膀胱瘘1例报告

结肠膀胱瘘是结肠炎性及肿瘤比较少见的并发症之一 ,早期诊断比较困难 ,处理也比较棘手。我们于 2 0 0 2年 5月收治了 1例乙状结肠恶性肿瘤并发结肠膀胱瘘 ,治疗效果满意 ,现报告如下。患者 ,男性 ,65岁 ,因尿频、尿急伴排尿时尿道烧灼样疼痛、气尿、粪尿两周入院。院外曾接受过抗生素治疗 ,但无明显疗效。近一周患者未解大便 ,但无明显的恶心及呕吐 ,无腹痛及腹胀 ,也无寒战及发热现象。查体 :左下腹部可扪及一质硬固定的包块。直肠指诊 :指套无血染。相关的实验室检查 :白细胞总数为 8.0× 1 0 9/L,其中中性粒细胞 0 .83,淋巴细胞占 0 .1…     

乙状结肠全去带原位膀胱术12例

 【摘要】　目的　分析乙状结肠全去带原位新膀胱术的应用价值。方法　膀胱癌12例，均采用根治性膀胱切除及乙状结肠全去带新膀胱术治疗。结果　12例患者随访6～29个月，平均18.6个月。患者血肌酐（Cr）、尿素氮（BUN） 均正常，未出现酸中毒。膀胱造影仅1例出现单侧输尿管反流。白天可自控排尿11例（91.7 ％），夜间尿失禁2例（16.7 ％），1例可通过夜间唤醒控制。新膀胱容量220～550 ml（平均350 ml），新膀胱充盈时最大压力15～55 cm H2O（平均35 cm H2O，1 cm H2O = 0.098 kPa）。结论　乙状结肠全去带原位新膀胱术式操作简单，并发症少，患者原位排尿，疗效可靠。     

乙状结肠套叠代膀胱术防止逆行性感染30例临床分析

作者2006年1月至2011年12月行膀胱全切除后乙状结肠代膀胱套叠术30例,防止逆行感染取得了较好的治疗效果,现总结报道如下。1资料与方法1.1临床资料本组30例患者均经病理确诊为膀胱癌,其中男性21例,女性9例;年龄33～68岁;病程8     

根治性膀胱全切去带乙状结肠原位膀胱术的手术配合

总结了11例膀胱肿瘤患者行根治性膀胱全切去带乙状结肠原位膀胱术的术前、术中护理配合经验。患者手术过程顺利,术后随访恢复良好。术前器械物品的充分准备、术中熟练地配合是保证手术顺利进行的关键。     

上尿路移行细胞癌术后预防性膀胱灌注的临床研究

目的:探讨上尿路移行细胞癌术后预防性膀胱灌注的有效性。方法:61例上尿路移行细胞癌患者行根治性切除术,其中34例患者术后预防性使用吡柔比星膀胱灌注,27例患者单纯随访,比较两组患者2年内膀胱肿瘤的发生率以及发生时间,并观察药物灌注毒副反应发生的情况。结果:吡柔比星灌注组膀胱癌发生率为14.7%,观察随访组膀胱癌的发生率为37.0%,差异有统计学意义(P<0.05),再发时间分别为20个月和14个月,二者比较差异有统计学意义(P<0.05)。患者灌注过程中均耐受,未出现中止灌注的情况。结论:本研究初步显示,吡柔比星预防性膀胱灌注可有效减少膀胱肿瘤的发生,毒副反应少,值得临床推广。     

1例乙状结肠癌并结肠膀胱瘘超声的表现

1临床资料患者,男,71岁,因腹泻伴高热,尿中混有粪渣样物半月余来我院住院治疗.B超检查示:肝胆脾胰腺及双肾未见占位性病变,右下腹部至膀胱底部可见大小为6.3 cm×5.7 cm的中等强度光团回声,内可见片状低回声(图1).彩色多普勒(CDFI)表现:内部及周边可见少量血流信号.肿块形态不规则,未见明显包膜,向膀胱腔内突入,膀胱壁不均匀增厚,最厚处1.6 cm,肿块与部分肠管粘连,粘连处肠壁不均匀增厚.患者取坐位,饮水500 mL后观察,膀胱内可见少量颗粒状中等回声.超声提示:(1)右下腹部至膀胱底部实性占位,考虑结肠癌侵犯膀胱;(2)结肠膀胱瘘.     

可控性回结肠膀胱

为探讨一种既尿可控，又少并发症的尿流改道术。１９９２年５月－１９９７年５月对１２例病人施行可控性回结肠膀胱术。随访１个月－５年。全组病人均尿可控，不挂尿袋，除１例外，１１例血生化，肾功均正常，１１例健在，均恢复正常社交活动或劳动。经贮尿囊造影，测压和ＩＶＰ检查，证实本术式具有可靠的抗尿失禁，抗输尿管返流，贮尿囊容量大且压力低，插管导尿容量，及并发症少等优点。     

Leiomyosarcoma of the rectum: Report of three cases

Leiomyosarcoma is a malignant tumor which rarely occurs in the rectum. Three patients with leiomyosarcoma of the rectum are presented. Treatment should include wide surgical excision followed by adjuvant chemotherapy. Emphasis is placed upon computerized tomography as the method of choice for the diagnosis of recurrent disease. Recurrent tumor should be resected whenever possible.     

低位直肠癌147例外科治疗

目的　为使低位直肠癌手术切除范围更合理 ,降低术后局部复发率 ,减少因人工肛门所造成的痛苦。方法　对 14 7例低位直肠癌外科手术进行回顾性分析。行各种方式的保肛手术 79例 ,行Mile′s手术 68例。Duke′s分期 :A期 17例 ,B期 72例 ,C期 5 8例。结果　本组无瘤生存 3年以上 93例占 72 .1% ;五年以上 71例占 63 .4%。术后局部复发 42例占 2 8.9%。其中盆腔内复发 2 7例占 64 .3 % ( 2 7/42 ) ,坐骨直肠窝内复发 5例占 11.9% ( 5 /42 ) ,吻合口复发 4例占 9.5 % ( 4 /42 )。局部复发与肿瘤病理类型及Duke′s分期有关 ,而与手术方式无关。结论　对低位直肠癌肿瘤分化程度高 ,Duke′s分期为B期、C期患者应适当扩大手术切除范围。对于肿瘤下缘距齿状线 3～ 4cm以上的低位直肠癌应尽可能争取行保肛手术并强调适当扩大盆腔内清扫范围是降低低位直肠癌手术后局部复发的关键     

Analysis of radical cystectomy and urinary diversion complications with the Clavien classification system in an Italian real life cohort

Introduction

Standardized methods of reporting complications after radical cystectomy (RC) and urinary diversions (UD) are necessary to evaluate the morbidity associated with this operation to evaluate the modified Clavien classification system (CCS) in grading perioperative complications of RC and UD in a real life cohort of patients with bladder cancer.

Materials and methods

A consecutive series of patients treated with RC and UD from April 2011 to March 2012 at 19 centers in Italy was evaluated. Complications were recorded according to the modified CCS. Results were presented as complication rates per grade. Univariate and binary logistic regression analysis were used for statistical analysis.

Results

Results and limitations: 467 patients were enrolled. Median age was 70 years (range 35–89). UD consisted in orthotopic neobladder in 112 patients, ileal conduit in 217 patients and cutaneous ureterostomy in 138 patients. 415 complications were observed in 302 patients and were classified as Clavien type I (109 patients) or II (220 patients); Clavien type IIIa (45 patients), IIIb (22 patients); IV (11 patients) and V (8 patients). Patients with cutaneous ureterostomy presented a lower rate (8%) of CCS type ≥IIIa (p = 0.03). A longer operative time was an independent risk factor of CCS ≥III (OR: 1.005; CI: 1.002–1.007 per minute; p = 0.0001).

Conclusions

In our study, RC is associated with a significant morbidity (65%) and a reduced mortality (1.7%) when compared to previous experiences. The modified CCS represents an easily applicable tool to classify the complications of RC and UD in a more objective and detailed way.     

Outcomes of urinary diversion after surgery for locally advanced or locally recurrent rectal cancer with complete cystectomy; ileal and colon conduit

IntroductionSurgery for locally advanced rectal cancer (LARC) or locally recurrent rectal cancer (LRRC) may require total pelvic exenteration with the need for urinary diversion. The aim of this study was to describe outcomes for ileal and colon conduits after surgery for LARC and LRRC.MethodsAll consecutive patients from two tertiary referral centers who underwent total pelvic exenteration for LARC or LRRC between 2000 and 2018 with cystectomy and urinary reconstruction using an ileal or colon conduit were retrospectively analyzed. Short- (≤30 days) and long-term (>30 days) complications were described for an ileal and colon conduit.Results259 patients with LARC (n = 131) and LRRC (n = 128) were included, of whom 214 patients received an ileal conduit and 45 patients a colon conduit. Anastomotic leakage of the ileo-ileal anastomosis occurred in 9 patients (4%) after performing an ileal conduit. Ileal conduit was associated with a higher rate of postoperative ileus (21% vs 7%, p = 0.024), but a lower proportion of wound infections than a colon conduit (14% vs 31%, p = 0.006). The latter did not remain significant in multivariate analysis. No difference was observed in the rate of uretero-enteric anastomotic leakage, urological complications, mortality rates, major complications (Clavien-Dindo≥3), or hospital stay between both groups.ConclusionPerforming a colon conduit in patients undergoing total pelvic exenteration for LARC or LRRC avoids the risks of ileo-ileal anastomotic leakage and may reduce the risk of a post-operative ileus. Besides, there are no other differences in outcome for ileal and colon conduits.     

去管化回肠S型缝合制作正位新膀胱三例报告

 【摘要】　目的　评价去管化回肠S型缝合制作正位新膀胱的临床应用价值。方法　膀胱癌患者行膀胱全切后，采用带蒂末段回肠片经S形折叠后缝合形成的原位类球形新膀胱，输尿管以乳头法包埋术种植于新膀胱，新膀胱远端与尿道残端吻合。结果　3例患者平均手术时间为5 h，术中平均出血量366 ml，术后随访1～18个月，3例白天均能控尿，夜尿1～3 次，膀胱容量大，压力低，血电解质基本正常。超声检查无上尿路扩张积液，MRI或膀胱镜检查无肿瘤复发，术后随访1～18个月，患者控尿、排尿满意，贮尿囊容量分别为250、320和450 ml，平均340 ml，剩余尿0～40 ml。结论　去管化回肠S型缝合制作正位新膀胱术操作简便，新膀胱容量大、术后并发症发生率低，是治疗浸润性、多发性膀胱癌的好方法。     

直肠平滑肌肉瘤:6例报告及国内文献72例分析

 本组收集78例直肠平滑肌肉瘤(本院6例，国内文献72例)患者。男性45例，女性33例；年龄1～79岁。主要临床症状为：肛门坠痛(55.1%)，便秘(53.8%)，血便(37.2%)，大便变形(35.9%)，腹泻(16.7%)，排尿困难(5.1%)。97.4%的患者进行了手术治疗，其中Miles术54例，肿瘤部分切除术16例，结肠造瘘术6例，放疗1例，放弃治疗1例。本文对直肠平滑肌肉瘤的发病率、病理、诊断和治疗进行了讨论。     

恶性膀胱非尿路上皮肿瘤（附10例报告）

目的探讨恶性膀胱非尿路上皮肿瘤的诊断及治疗。方法回顾性分析10例恶性膀胱非尿路上皮肿瘤的临床资料。行膀胱全切术6例,膀胱部分切除术1例,经尿道膀胱肿瘤电切术（TURBt）2例,1例膀胱小细胞癌因广泛浸润仅作探查活检术。结果恶性膀胱非尿路上皮肿瘤占同期恶性膀胱肿瘤的4.5%。10例随访2月-5年,术后平均生存时间17.4月。结论恶性膀胱非尿路上皮肿瘤临床少见,预后差,膀胱全切术是首选的手术方式,新辅助化疗或术后放化疗可提高疗效。     

Double-barreled wet colostomy is a safe option for simultaneous urinary and fecal diversion. Analysis of 56 procedures from a single institution

BACKGROUND AND OBJECTIVES: Wide pelvic tumors need urinary and fecal diversion. We set out to assess the efficacy of the double-barreled wet colostomy (DBWC) in patients undergoing simultaneous double diversion. MATERIAL AND METHODS: We reviewed 56 consecutive patients submitted to surgery, divided into two groups: (1) total pelvic exenteration plus DBWC (n = 26); (2) DBWC without simultaneous pelvic resection (n = 30). Pelvic tumor recurrences accounted for most patients (n = 53), whereas the remaining three patients suffered from actinic pelvic complications. RESULTS: Surgical morbidity and mortality rates were 53.8% (14/26) and 11.5% (3/26) in Group 1, and 43.5% (13/30) and 3.3% (1/30) in Group 2, respectively. Only 2 patients out of 51 (3.9%) developed late postoperative urinary tract infection. Regression of the hydronephrosis was observed in 28 out of 33 assessable patients. Median survival in Groups 1 and 2 was 8.36 and 4.14 months, respectively. In the subgroup of patients submitted to curative surgery (n = 24), actuarial cancer-specific survival rate in 2 years was 58.78%. CONCLUSION: DBWC is a safe and efficient alternative for simultaneous urinary and fecal diversion, with low morbidity and mortality rates, improvement of renal insufficiency, and low risk of postoperative urinary tract infection.