乙状结肠直肠膀胱尿流改道术的临床应用

目的观察膀胱全切后乙状结肠直肠膀胱术作为尿流改道的临床效果。方法 12例膀胱癌患者行膀胱全切术乙状结肠直肠膀胱术尿流改道,利用肛门括约肌控制排尿。术后随访3～24个月,平均7.4个月。结果 12例患者手术均顺利完成,术中出血400～1200 ml,输血400～800 ml,术后拔除肛管后即进行肛门括约肌功能训练1,0～12 d后拔双侧输尿管支架管后均能达到良好的控尿功能。1～1.5 h排尿1次,其中有2例患者短期内出现夜间不能控尿,经过训练在1～2周后均能完全控制排尿排便。随访3～24月,平均7.4个月,患者2个月后每日排尿次数稳定,平均间隔2～3.5 h 1次,术后无1例出现高氯性酸中毒。术后3～6个月行IVP检查上尿路排泄正常,无梗阻、积水、输尿管扩张和返流;代膀胱容量300～400 ml,排尿后残余尿量0～50 ml。结论该术式简单易行,易于掌握,手术时间短,术后并发症少,临床效果肯定,是可控性尿流改道手术可供选择的术式之一。

Clinical application of sigma rectum pouch for urinary diversion

Objective To investigate the clinical outcome of sigma rectum pouch as a continent form of urinary diversion.Methods The clinical data of 12 patients who underwent a sigma-rectal pouch procedure were analyzed retrospectively.Patients controlled the urine by anal sphincter after operations and were followed up for 3 to 24 months with mean of 7.4 months postoperatively.Results All 12 operations were performed successfully(blood lose 400~1200 ml,blood transfusion 400~800 ml),and the operation time was 180~260 minutes with a mean of 200 minutes in totally.Began the anal sphincter function training as soon as removed the anal tube,the ureteral stents in the both sides were removed at day 10~12 postoperatively,and all the patients achieved a good function for controlling the urine.Urinated one time per 1~1.5 h.Two patients had incontinence of urine during the night in a short period postoperatively;however,after 1~2 weeks training,they also could control the urine well.According to followed-up,2 months after the operation,the everyday urine times became stable(one time per 2~3.5 h).There was no hyperchlorine acidosis happened in the 7 cases.Intravenous pyelography was performed at 3-6 months after the operation,and it showed that the upper urinary tracts were working well and without anastomotic stricture,hydronephrosis,ureterectasis or ureteral reflux.The volume of pouch was 300~400,while the volume of residual urine was 0~50 ml.Conclusion A modified sigmoid rectal pouch procedure provides a reservoir with a higher capacity and lower pressure without a reflux to the upper urinary tract and descending colon with lower incidence of complication,it is a promising method,which is superior in small incision,rapid recovery,and easy performance.It is also a better alternative diversion procedure that would be easily accepted by surgeons and patients.