阑尾与尿道吻合的回盲肠代膀胱手术远期疗效观察(附11例报告)

目的　评价阑尾与尿道吻合的回盲肠代膀胱手术远期疗效。　方法　应用回盲肠作贮尿囊 ,阑尾代后尿道原位排尿的方法治疗膀胱肿瘤病人 5 6例。　结果　 11例病人术后获 10年以上随访。其中白天完全自控排尿 10例 ,夜间完全自控排尿 8例。伴后尿道假性瓣膜 2例 ,贮尿囊内继发结石 1例 ,后尿道狭窄 1例 ,无输尿管返流 ,无高氯性酸中毒。贮尿囊容量 2 90～ 5 2 0ml,平均 388ml,压力 2 3～ 36cmH2 O(1cmH2 O =0 .0 98kPa) ,平均 2 8cmH2 O。平均尿流率 9.6ml/s。　结论　阑尾与尿道吻合的回盲肠代膀胱术式具有贮尿囊内压低 ,容量大 ,可控性和原位排尿的优点 ,是一种较理想的尿流改道方式。

Long term follow up of ileocecum-appendix pouch for the replacement of urinary bladder(report of 11 cases)

Objective To evaluate the long term outcome of the continent urinary reservoir constructed with ileocecum appendix. Methods From 1985 to 1992,continent urinary reservoir was constructed by using ileocecum appendix after radical cystectomy for 56 patients,of which 11 have been followed up for over ten years. Results The daytime continence rate was 90% and the night continence rate 80%.The average capacity of the urinary pouch has been 388 ml,and the mean pressure 28 cm H 2O.The average urine flow rate is 9.6 ml/s.No evidence of ureteral reflux and no hyperchloremic acidosis have been observed.Stone formation in the pouch occurred in 1 patient,pseudo valve in the posterior urethra in 2 and stricture of the posterior urethra in 1. Conclusions Continent ileocecum appendix pouch might be considered as an ideal form of urinary diversion,characterized by low pressure,large capacity,continent and in situ urination.