贮尿囊与腹壁的壁外支持增强缩窄回肠控制机制的临床研究

目的：建立一种控尿可靠、导尿容易和手术方法简单的输出管。方法：选用缩窄后的回肠作为输出管，输出管的内口与贮尿囊作端侧吻合，其外口与脐孔作端端吻合，并将部分输出管固定在贮尿囊与腹壁之间的手术方法治疗10例膀胱癌患者。术后对输出管和贮尿囊作尿动力学和X线检查。结果：1例术后55d死于心脏疾病，余9例中8例白天和晚上均能控制排尿，术后尿动力学检查示贮尿囊充盈时输出管最大闭合压明显高于贮尿囊空虚时输出管最大闭合压，两者间比较差别有显著性意义（t=-7.14,P=0.000098)。结论：采用回肠贮尿囊与腹壁的壁外支持可明显增强缩窄回肠的控制能力。

A clinical study of enhanced continent mechanism of tapered ileum by extramural support from pouch-abdominal wall

Objective To construct a reliable continent tube, which is easy to catheterize and is surgically simple. Methods 10 patients with bladder cancer underwent a procedure in which ileal segment was tapered as an efferent tube,a part of which was placed between the back surface of the rectus muscle and wall of the ileal pouch. Internal orifice of the tapered ileum was anastomosed to the ileal pouch and external orifice of the tapered ileum was anastomosed to umbilicus. Urodynamic and radiological studies were carried out postoperatively on 9 patients. Results The stoma could be easily catheterized with a 16 F catheter in all the patients. One patient died of heart disease 55 days postoperatively. In the other 9 patients, 8 were completely continent day and night. The urodynamic study of the efferent tubes showed a maximum close pressure with a full pouch was significantly higher than those with an empty pouch (t=-7.14,P=0.000098 ). Retrograde radiogram of the efferent tubes showed perfect canalization without stenosis. Conclusion This study suggested that the continent mechanism of tapered ileum can be greatly enhanced by fixing it between the abdominal and the pouch wall,allowing also easy catheterization and surgical simplicity.