改良Sigma直肠膀胱术

目的：评价改良Sigma术式可控性尿流改道的临床疗效。方法：对14例膀胱、前列腺肿瘤患者采用改良Sigma术式。折叠乙状结肠约25cm后全层切开，再缝合成低压袋，顶端固定在骶岬处，两输尿管末端合并吻合并外翻形成乳头，从低压袋上方引入再植。结果：全膀胱切切险后的直肠膀胱术平均手术时间65min。术后1例发生直肠阴道瘘，经横结肠造口后瘘口自愈；1例左肾积水伴上尿路感染者经输尿管顺行扩张后恢复正常，患者术后3个月发生血钾，补充枸橼酸钾后治愈。全组无尿失禁，肾功能损害及严重上尿路感染等并发症。结论改良Sigma手术时间短，对肠管扰动小、操作简便、术后尿控满意，上尿路积水，感染、电解质紊乱等并发症少，可明显提高患者生活质量。

A modified technique of Sigma operation

Objective　To introduce a modified technique of Sigma operation as a continent urine reservoir after radical cystectomy.Methods　14 cases of bladder cancer or prostate Carcinoma underwent the modified Sigma pouch operation from Feb.1998 to Dec.1999.A segment of sigmoid colon was folded and a longitudinal incision about 25 cm was made on the sigmoid wall and the incision was sutured so as to form a low pressure pouch.The vertex of the new pouch was fixed to the sacrum.The ends of the 2 ureterers were anastomosed together to form a big nipple and was then drawn into the top of the pouch for 2～3 cm and finally the ureterosigmoidostomy was accomplished.Results　The procedure took about 65 minutes after radical cystectomy.Early postoperative complications occurred in 2,a rectovaginal fistula was cured by temporary colostomy and a hydronephrosis with hypokalemia in another patient cured by percutaneous ureter dilatation and oral replacement of potassium salt.All the patients were urinary continent.Symptomatic renal infection and hyperchloremic acidosis occurred seldomly.Conclusions　The procedure is a safe method of urinary diversion.Good continence has been achieved and the patients could be free from troublesome of urine bag or intermittent catheterization.The upper urinary tracts are free from trouble.The life quality of patients would be markedly improved.