摘要
目的探讨改良可控性回肠膀胱临床应用的效果.方法膀胱癌行根治性膀胱切除尿流改道患者12例,采用改良的回肠乳头瓣作为输出道,外口与脐孔作皮瓣嵌入防狭窄吻合,去管化回肠浆膜下隧道抗返流技术.结果12例随访14～50个月,昼夜控尿满意,尿动力学显示:储尿囊容量350～720(435±88)ml,充盈时内压15～32(20±5)cm H2O,储尿囊充盈时输出道最大闭合压力74～142(98±23)cm H2O,空虚时为49～105(68±20)cm H2O,2者差异有统计学意义(t=8.82,P<0.01);充盈过程中无收缩波出现.结论改良回肠乳头瓣输出道及去管化回肠浆膜下隧道抗返流技术是比较理想的可控技术改进.
Objective To construct a good and reliable continent urinary diversion which is easy to catheterize and has a low incidence of complications. Methods Twelve cases of bladder cancer underwent radical cystectomy and urinary diversion. In them ,the ileal papillary valve was changed as an efferent conduit and its external orifice of the modified ileum was anastomosed to the umbilicus,the ureter was anastomosed to the wall of detubularized ileal pouch by Le Duc rebel reflux. Results All the 12 patients were followed up for 14 - 50 months. All had satisfactory urinary continence day and night. Urodynamic data showed that the reservoir capacity was 350 to 720 （435 ± 88 ） ml and the mean maximum filling internal pressure was 15 - 32 （20 ±5）cm H2O;the maximum closure pressure of efferent conduit with a full pouch was 74 - 142 （98 ± 23 ） cm H2O ,and when the pouch was empty it was 49 - 105 （68 ± 20） cm H2O. The difference in the mean maximum closure pressure between full and empty pouches was statistically significant （ t = 8.82, P 〈 0.01 ）. There was no contractive wave in filling in any patients. Conclusions The modification of ileal papillary valve as an efferent conduit produces excellent urinary continence; and detubularized ileal pouch by Le Duc rebel reflux has satisfactory anti-reflux and anti-stricture effects. This is an ideal method of continent urinary diversion.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第10期692-694,共3页
Chinese Journal of Urology
