回肠折叠包埋式输尿管抗返流吻合的临床应用

为证实回肠折叠包埋式输尿管抗返流的低压回肠代膀胱术的实用价值，自１９９２年８月－１９９５年１月，对１２例膀胱癌患者施行回肠折叠包埋式输尿管抗返流的低压回肠代膀胱术，随访３－２９个月，患者可获得近似生理状态的排尿，无尿失禁及残余尿。术后定期膀胱造影，未发现明显输尿管返流。回肠折叠包埋式输尿管抗返流吻合，操作简单，效果可靠，值得临床应用。     

肠代膀胱术中回肠反套入抗输尿管返流方法的临床研究

目的 评价肠代膀胱术中回肠反套入的抗输尿管返流作用。方法 患者5例，男4例，女1例。年龄48～67岁，平均61岁。均为浸润性移行细胞癌，行膀胱全切、回肠正位膀胱术。距回盲部屈氏韧带15cm处切取回肠30cm，近端回肠反套入4cm，回肠段远端肠管对系膜缘纵形剖开，U形缝合；套入肠管与对应肠片均切除1cm宽之黏膜，相应浆肌层可吸收线固定4针，对应黏膜缘缝合，防止套入肠管滑脱；双侧输尿管远端剖开6cm，侧侧吻合后经套入肠管引入，吻合口与套入肠管口间断缝合；U形肠管对折成储尿囊，与尿道吻合。术后定期行血生化、双肾B超、排泄性膀胱造影和尿动力学检查。结果 5例患者随访10～33个月。排尿次数白天3～5次，夜间0～3次；日间控尿100％，夜间控尿80％；尿动力学检查：最大尿流率9．5～31．5ml／s，膀胱容量350～710ml，平均433ml；剩余尿50～305ml；最大膀胱排尿压23～52cmH2O；膀胱出口无梗阻。B超检查双肾无积水。膀胱造影未见输尿管返流。结论 回肠正位膀胱术中回肠反套入方法有良好的抗输尿管返流作用。     

无抗返流机制回肠原位新膀胱肾功能和上尿路形态的评价

远期肾功能对接受肠代膀胱的患者至关重要，受输尿管梗阻、尿路感染和尿液返流等因素的影响。作者研究了无抗返流机制低压回肠代膀胱的肾功能损害和上尿路形态改变的发生率。1996—2002年间，70例男性患者接受了短输入支、无抗返流的输尿管小肠吻合W形代膀胱，于2003年11月对患者状态进行最终评价。有20例患者在随访期间死亡，另50例平均随访时间50个月(21～89个月)。     

低压抗反流回肠代膀胱术51例临床分析

回肠膀胱术（Bricke术）至今已有半个多世纪，此期间尿流改道技术已有了长足的发展，作为尿流改道的金标准各种恢复从尿道排尿的代膀胱术倍受关注，深受患者欢迎。大连医科大学附属第二医院与上海新华医院泌尿外科自2001年3月以来对51例根治性膀胱切除术患者采用低压抗反流回肠代膀胱术，疗效满意。     

低压回肠双重抗反流代膀胱术疗效观察(附4例报告)

目的：改善根治性膀胱全切除术后患者的生活质量。方法：对４例膀胱癌膀胱全切除术后行可控低压回肠双重抗反流代膀胱术,采用肠管套入乳头瓣及输尿管“Ｙ”形孔头袖套式膀胱吻合双重抗反流。结果：随访１￣３年,代膀胱内压力低、顺应性好、容量大,抗反流好,能有效地预防逆行感染,无水、电解质紊乱,无输尿管扩张、梗阻,白天自控排尿良好。结论：对可保留尿道的膀胱癌患者是一种较理想的膀胱替代手术。     

全腹膜外式回肠膀胱术的临床应用

采用全腹膜外式回肠膀胱术治疗１３例膀胱肿瘤患者，结果１２例患者术后恢复顺利，１例术后３周出现漏尿，加强引流后自行愈合。术后随访６～８个月，双肾无积水，可参加一般社会活动。认为本术式简便、合理，并发症少，且易于控制。     

体外可控性回肠膀胱术的实验研究及临床应用

目的　提高体外可控性回肠膀胱术的治疗效果。　方法　距回盲部约 2 0cm处切取一段回肠 ,中间部分折叠成N形并缝制成贮尿囊 ;近端回肠为输入道 ,近贮尿囊 4～ 5cm回肠纵形折叠缝合以缩窄管腔 ;远端 8～ 10cm回肠从腹壁造瘘口处穿出体外 ,于造瘘口处取双片梯形皮瓣包绕外露肠管缝制成皮管 ,构建输出道。将尿液控制器置于皮管外 ,利用气囊控制排尿。 12只犬应用研究后对 5例膀胱癌患者采用此术式治疗。　结果　 10只犬手术顺利 ,术后 3个月时贮尿囊平均最大容量 (15 0± 4 0 )ml,最大充盈压 (2 4 .4± 5 .3)cmH2 O。 5例患者术后随访 3～ 14个月。术后 3个月时贮尿囊平均最大容量 (2 90± 80 )ml,最大充盈压 (36 .3± 8.2 )cmH2 O ,最大尿流率 (2 0 .3± 4 .7)ml/s ,无剩余尿。影像学检查肾脏显影良好 ,输尿管通畅。尿液控制器气囊充气后无尿液流出 ,气囊消气后尿线粗。　结论　该尿流改道术式可达到体外控尿效果 ,不必佩戴集尿袋及导尿 ,手术操作比较简单、并发症少。     

女性原位回肠代膀胱术的临床应用

目的:总结女性膀胱全切患者行原位回肠代膀胱术的临床疗效。方法:回顾性分析1998年1月～2006年2月36例女性膀胱全切,原位回肠代膀胱患者的临床资料。36例患者,年龄48～65岁,平均56岁。其中移行细胞癌34例,腺癌2例。原发肿瘤22例,复发性肿瘤14例。多发性非肌层侵犯肿瘤(Ta～T1)12例,浸润性膀胱肿瘤(T2～T3)24例。结果:36例手术平均时间270min(210～330min),输血量平均400ml(0～1000ml)。术后随访6～72个月,平均26个月。术后6个月昼夜控尿率分别为94%(34/36)和92%(33/36)。2例排尿可控过度,需间歇导尿。术后6个月IVU检查无输尿管狭窄和反流。血电解质和肾功能正常,无尿道残端肿瘤复发。结论:原位回肠代膀胱术治疗女性膀胱癌患者临床疗效满意,可作为广泛开展的术式。     

The ileopsoas tunnel,a new antireflux technique for ureteroileal reimplantation: an experimental study in dogs

A new antirefluxing ureteroileal anastomosis is described in which the implantedureter is placed between the ileal segment and psoas muscle. The procedure was studied in eight experimental dogs, which were observed for 20 weeks. Radiologic and bacteriologic examinations, necropsy assessment and histopathologic results provided evidence that this ileo-psoas tunnel technique allows a unidirectional, non-obstructed flow of urine. The technique could be applied when ileal replacement of the ureter is necessary or in association with continent bladder replacement.     

可控膀胱增强缩窄回肠控制机能的临床研究

目的设计一种控尿可靠,导尿容易和手术方法简单的可控膀胱输出道. 方法对20例尿流改道的患者,采用缩窄的回肠作为输出道,并将部分输出道固定在回肠储尿囊与腹壁之间,输出道的内口与回肠储尿囊作端侧吻合,其外口与脐孔作端端防狭窄吻合的手术方法治疗.术后1.5～3个月和6～ 17个月分别对输出道和储尿囊行尿动力学检查. 结果 1例术后55 d死于心脏疾病,其余19例中,18例术后昼夜能控制尿.术后1.5～3个月尿动力学显示储尿囊充盈时输出道最大闭合压为46～124(92±17)cmH2O(1 cmH2O=0.0 98 kPa),空虚时34～84(67±12)cmH2O,两者间差异有非常显著性意义(t=10.5 9, P＜0.01);6～17个月12例行尿动力学检查,储尿囊充盈时输出道最大闭合压为7 7～154(101±21)cm H2O,空虚时为56～115(74±15) cm H2O,两者差异有非常显著性意义(t=8.54, P＜0.01);储尿囊容量为360～750 (455±111)ml,充盈时内压为16～35(23±6)cmH2O,充盈过程中没有收缩波出现. 结论储尿囊与腹壁的壁外支持可明显增强缩窄回肠的控尿能力,这种术式还具有导尿容易和手术方法简单的特点.     

机器人腹腔镜根治性膀胱切除原位回肠新膀胱术中手术室护理配合的意义

目的探讨达芬奇机器人辅助腹腔镜下膀胱根治性切除原位回肠新膀胱手术的护理配合流程,评估其临床意义。 方法回顾性分析2016年1月至2017年12月93例达芬奇机器人辅助腹腔镜膀胱根治性切除原位回肠新膀胱手术患者的临床资料,阐述机器人腹腔镜手术围手术期护理配合自身特点。根据开展手术的时间,分为早期组和后期组,比较两组机器人准备时间、手术时间、出血量、并发症发生率等指标。 结果93例手术均顺利完成,无中转开腹,护理配合满意。早期组与后期组机器人准备时间[（50±10）min vs （30±5）min]和手术时间[（305±25）min vs （255±20）min]差异具有统计学意义;出血量早期组略大于后期组[（110±20）ml vs （95±15）ml],差异有统计学意义;均未发生明显并发症。 结论娴熟的护理配合在机器人腹腔镜膀胱根治性切除术中具有较重要的意义,通过节省准备时间、优化机器布局、术中熟练配合等方面,最终使整个手术得以顺利、高效的开展。     

机器人辅助回肠膀胱扩大术治疗神经源性膀胱的初步经验

目的:探讨机器人辅助回肠膀胱扩大术治疗神经源性膀胱的可行性、安全性和临床疗效。方法:回顾性分析2017年3月至2018年11月浙江省人民医院收治的12例神经源性膀胱患者的病例资料,男11例,女1例。平均年龄38(12~67)岁。12例术前均有尿失禁、排尿障碍以及膀胱安全容量减小、膀胱内压力增高导致输尿管反流等症状,病因...     

A systematic review of symptomatic hamartomas of the jejunum and ileum

IntroductionGastrointestinal hamartomas are rarely encountered benign growths made of an abnormal mixture of tissues normally found in the body where the growth occurs. Most hamartomas are asymptomatic and diagnosed incidentally. Evidence regarding symptomatic hamartomas of the jejunum and ileum is limited and restricted to anecdotal case reports. We aim to provide a contemporary overview to clarify various aspects linked to symptomatic hamartomas, helping aide management and clinical decision-making.MethodsThe search terms ‘small bowel’, ‘small intestine’, ‘jejunum’ and ‘ileum’ were combined with ‘hamartoma’. Embase, Medline, PubMed searches and Google Scholar hand-searches were conducted. All English language papers from 1 January 2000 to 1 June 2020 were included.ResultsIn total 39 cases were reviewed: 29 adults and 10 paediatric (0–16 years). Presenting symptoms included abdominal pain (87%), vomiting (56%), gastrointestinal bleeding (20.5%) and weight loss (5%); 36 of 39 cases (92%) presented as emergencies. Diagnostic investigations included: abdominal x-ray (49%), endoscopy (38%), computed tomography (56%), magnetic resonance imaging (5%), contrast study (15%) and video capsule endoscopy (5%). Initial management strategy was either open (30) or laparoscopic (7) surgery or endoscopy (2). All cases required surgery for definitive management. Twenty-five cases recorded hamartoma size, and mean maximum diameter was 3.56cm (1.2–8cm) with stricturing in seven cases. Nine of the 39 cases were associated with hamartomatous syndromes. Two mortalities were recorded.ConclusionsThis is the first published review addressing symptomatic hamartomas of the jejunum and ileum. New data relating to demographic cohort, symptom profile, investigations, management strategies, and morbidity and mortality provide greater insight to those encountering this challenging clinical finding in the future.     

Primary malignant fibrous histiocytoma of the ileum: report of a case

We report herein a case of primary malignant fibrous histiocytoma (MFH) of the ileum. A 71-year-old Japanese man was admitted to our hospital with symptoms of abdominal pain and anorexia. Computed tomography, magnetic resonance imaging, a follow-through study of the small intestine, and angiography all demonstrated a tumor of the ileum suggestive of a primary malignancy. A partial resection of the ileum was performed. It was histopathologically and immunohistochemically diagnosed to be a storiform-type primary MFH of the ileum with peritoneal dissemination. There have been a total of 25 cases of primary small bowel MFH documented in the Japanese or Western literature including our case. The malignant potential of such tumors is high, and the prognosis tends to be very poor. Unfortunately, we could not conclude whether the poor outcome was due to a delayed diagnosis or instead to its biological malignant behavior, since the number of such reported cases is still too small to make any definitive conclusions. Received: August 10, 2000 / Accepted: March 6, 2001     

Studer回肠代膀胱术的技术改进和临床应用

目的：探讨Studer回肠代膀胱术技术改进的临床应用价值。方法：对Studer回肠代膀胱术进行技术改进，包括缩短输入道回肠、先作成贮尿囊和完成输尿管与输入道吻合口，最后贮尿囊尿道6针吻合、代膀胱前壁与耻骨悬吊固定等，并应用于35例患者。膀胱癌31例，晚期神经原性膀胱2例，腺性膀胱炎2例。患者均为男性，平均年龄6l岁。随访观察术后并发症、排尿功能和生活质量。结果：35例手术时间5．5--8．5h，平均6．5h。术中出血量300～l200ml，平均650ml，术中需输血21例。围手术期发生应激性溃疡6例，成人呼吸窘迫综合征(ARDS)l例。患者术后均恢复生理排尿，剩余尿40～60ml者5例，术后3个月和6个月的白天控尿率分别为91％和100％，夜间控尿率分别为87％和96％。上尿路功能良好，生活质量满意。结论：Studer回肠代膀胱术技术相对简单、并发症少、术后恢复快、符合生理性排尿、疗效满意，值得临床推广应用。     

Autocystectomy following extensive genitourinary tuberculosis: Presentation and management

Genitourinary tuberculosis is an important cause of morbidity in developing and developed countries. We describe a case of extensive genitourinary tuberculosis in which there was complete destruction of the right kidney, stricture of the entire left ureter and an autocystectomized bladder. He presented in azotemia with urinary incontinence and was managed by right nephroureterectomy, ileal replacement of left ureter and ileal neobladder after a preliminary nephrostomy and antituberculous chemotherapy.     

回肠代膀胱术后肠粘膜组织学的变化

目的：初步探讨回肠代膀胱术后贮尿囊粘膜的变化及意义。方法：选择12例平均年龄61岁、平均术后时间35个月患者的肠贮尿囊粘膜取材作光镜及电镜检查，并同时作血气分析。结果：随术后时间延长，肠绒毛及绒毛均逐渐萎缩，而上皮细胞的其他形态结构及层次均未见异常。1例术后半年者发生轻度酸中毒，其余患者正常。绒毛萎缩可导致杯状细胞总数减少。结论：随术后时间延长，回肠代膀胱酸中毒发生率下降，粘液堵塞尿道现象也可能减轻；随访期内肠上皮细胞未见增生等改变。     

Jackson骶骨棒内固定技术的解剖学研究及临床应用

目的探讨Jackson骶骨内置棒行腰骶部内固定的安全性,并将其用于治疗腰骶椎滑脱患者。方法在经S1、S2神经孔的CT扫描层面上测量80名志愿者的骶骨侧块横径和侧块后外侧径,以及髂骨对能骨后外侧都可能提供的支撑覆盖。应用该内固定技术治疗腰骶椎滑脱患者12例,滑脱百分率平均为34％。结果最小骶骨侧块横径和后外侧径分别为14.8mm和10．9mm,均明显大于Jackson骶骨棒的直径7.0mm,并且74.6％的受试者有良好的髂骨对骶骨后外侧提供的支撑覆盖。本组滑脱病例手术复位率平均72％,术后2周无外固定练习下床活动。随访6～24个月,患者腰腿痛消失,植骨呈骨性融合,无复位丢失,无断钉、断棒或内固定松动。结论Jackson骶骨棒内固定是安全可行的,对腰骶部滑脱可良好复位,术后无需卧床或外固定,近期效果满意。