摘要
目的 评价以阑尾为流出道的可控性回盲肠膀胱手术的远期疗效。 方法 应用回盲肠及部分升结肠作储尿囊 ,以阑尾为流出道腹壁造口术治疗膀胱肿瘤患者 4 6例 ,采用尿动力学方法随访 5年以上 2 1例。男 15例 ,女 6例 ,平均年龄 5 7岁。G2 12例 ,G3 9例。T3aN0 M0 11例 ,T3bN0 M05例 ,T3bN1M0 3例 ,T3bN0 M0 2例。 结果 2 1例患者中能控尿者 19例 (95 % )。白天导尿 4～ 5次 ,夜间 1～ 2次 ,每次量 2 5 0～ 4 0 0ml。膀胱初始感觉压力平均 2 8cmH2 O ,最大充盈压 36cmH2 O ,储尿囊容量分别为 2 6 5ml、4 5 0ml。阑尾流出道闭合压力 4 5cmH2 O。 1例患者出现肺转移行手术切除 ,1例出现肝转移死亡。无输尿管返流 ,无高氯血性酸中毒。 结论 以阑尾为流出道的回盲肠膀胱术储尿囊内压低、容量大、可控性好 ,是一种较理想的尿流改道方式。
Objective To evaluate the long-term effe ct of the continent urinary reservoir of ileocecum-colon with the appendix as out let. Methods Continent urinary reservoir of ileocecum-c olon with the appendix as outlet was performed in 46 patients with bladder tumor .Of them,21 patients (15 men and 6 women;mean age,57 years) were followed up by urodynamics for over 5 years.Pathologic grading showed G 2 in 12 cases and G 3 in 9;TNM staging showed T 3aN 0M 0 in 11 cases,T 3bN 0M 0 in 5,T 3bN 1M 0 in 3 and T 3bN 0M 1 in 2. Results Of the 21 cases,19 (95%) were of urinary continence.Catheterization was perfor med 4～5 times at daytime and 1～2 times at night; the volume was about 250～400 ml each time.On average the initial pressure of the reservoir was 28 cm H 2O (1 c m H 2O=0.098 kPa),and the maximal filling pressure was 36 cm H 2O;the correspo nding average capacity of the reservoir was 265 ml and 450 ml,respectively.The c losing pressure of the appendix outlet was 45 cm H 2O.One case developed lung m etastasis and underwent resection; 1 developed liver metastasis and died later.N o evidence of ureteral reflux and no hyperchloremic acidosis were observed. Conclusions Continent ileocecum-appendix pouch can be consi dered as an ideal form of urinary diversion characterized by lower internal pres sure and larger capacity of the urinary reservoir, and satisfactory continence.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第2期110-112,共3页
Chinese Journal of Urology
