乙状结肠直肠膀胱术18例

 【摘要】　目的　评价乙状结肠直肠膀胱术可控性尿流改道的临床效果。方法　对18例膀胱肿瘤患者行全膀胱切除后乙状结肠直肠膀胱术。以乙状结肠直肠交界为中点,将肠管纵行剖开20～24 cm,做乙状结肠直肠侧侧吻合,形成低压贮尿囊,顶端固定于骶骨岬处,两输尿管由贮尿囊上方引入,采用改良黏膜沟法做抗反流吻合,利用肛门括约肌控制排尿。结果　全膀胱切除后的乙状结肠直肠膀胱术平均手术时间为80 min。拔除肛管及输尿管支架管1周～2个月后可获得满意的尿便分流,2个月后排尿次数稳定,白天4～5次,夜间1～3次。术后并发夜间遗尿2例,2个月后自行消失;并发粘连性肠梗阻1例,高氯性酸中毒、低钾血症2例,尿道残端癌1例。无吻合口梗阻、肾功能损害及严重上尿路感染等并发症。结论　该术式操作简便,术后尿控满意,接近正常人的生活,易于被患者接受,是一种比较好的可控性尿流改道方式。

Sigma rectum pouch for urinary diversion(Report of 18 cases)

【Abstract】　Objective　To assess the continent diversion results of sigma rectum pouch after radical cystectomy. Methods　The reconstruction of bladder with sigmoid was modified for treatment of 18 cases of bladder tumor. The intestine was incised over a length of 20~24 cm with the junction of sigmoid colon and rectum as the midpoint so as to create a low pressure reservoir for urine and side-to-side anastomosis was performed on the posterior borders of the rectosigmoid wall. Submucosal tunnel modified technique was em－ployed in antireflux urethral implantation. Urination has been controlled by anal sphincter. Results　About 80 minutes was spent to finish a new low pressure pouch after radical cystectomy. Among l8 patients with this op－eration,the controlled emiction were good after pull out the anal duct and "J" stent in 1 week to 2 months. Af－ter 2 months, the times of urination is stable,4~5 times in daytime and 1~3 times during nighttime. Two pa－tients had nocturnal enuresis and the symptom vanished after 2 months. One patient had adhesive ileus, two patients had hyperchloremia acidosis and kaliopenia, one patient had urethral stump cancer. There is no com－plication as anastomotic block, renal function lesion and severe upper urinary tract infection. Conclusion　This operative method was easy, emiction control was well, and with higher quality of life for patients. It is al－so a better alternative diversion procedure that would be easily accepted.