根治性膀胱切除＋回肠原位新膀胱术后尿漏防治

目的探讨回肠正位新膀胱术后尿漏的原因及防治措施。方法回顾性分析102例行根治性全膀胱切除术＋回肠正位新膀胱术膀胱癌患者的临床资料。结果 102例患者中有9例发生尿漏,占8.8%。其中,新膀胱尿道吻合口漏5例,经局部引流等综合治疗后痊愈;输尿管代膀胱吻合口完全离断、输尿管腹腔漏2例,于术后即刻行输尿管与对侧输尿管端侧吻合痊愈;输尿管回肠漏1例,于术后1个月行输尿管代膀胱再次吻合后痊愈;代膀胱乙状结肠漏1例,术后2个月行结肠造漏、尿液充分引流治愈。结论回肠正位新膀胱术后尿漏的发生与吻合口近远端的血运不良、吻合口张力大、吻合器使用不当及合并有重度贫血、低蛋白血症等有关。膀胱尿道吻合口漏经牵引、引流、支持治疗可治愈,而出现腹腔内的漏尿,肠道内的漏尿需及时选用相应手术方法干预。

The prevention and treatment of anastomotic leakage after orthotopic ileal neobladder (Report of 9 ca-ses)

Objective To explore the cause and treatment of postoperative anastomotic leakage following orthotopic ileal neobladder. Methods The data of 102 patients（82 males and 20 female）with malignant bladder tumors underwent orthotopic ileal neobladder after radical cystoprostatectomy were reviewed. Results Anastomotic leakage after rthotopic ileal neobladder in 9 cases（8.8%）.For management of anastomotic leakage,5 cases were cured by conservative treatment and 4 cases were cured by surgery. Conclusions Anastomotic leakage in orthotopic ileal neobladder is a common complication after radical cystoprostatectomy,caused by multiple factors.The management for anastomotic leakage should be accord to the condition of patients,most of them need conservative treatment,the less of them need surgical intervention.