摘要
目的对直接吻合(即不经隧道式包埋处理)的膀胱小口径回肠输出道的可控性进行初步探讨。方法实验用小型猪15头,随机分为5组,每组输出道长度分别为4、5、6、7、8cm,每个动物各形成两个相同长度的小口径回肠输出道并直接与原位膀胱吻合,不做隧道式包埋,随后将输出道斜置于腹直肌内,经皮造口。术后8周行尿流动力学、影像学及组织学检查。结果尿流动力学及影像学检查显示5、6、7cm组的可控性输出道膀胱吻合口无狭窄,斜行于腹直肌内,无扭曲,结构稳定,插管顺利。膀胱平均容量400ml时的最大尿道压为5.15～12.19kPa,最大尿道闭合压为4.83～11.27kPa;可控性输出道的功能性尿道长度均大于2cm;3组间最大尿道压有显著性差异(P<0.05);而最大尿道闭合压及功能性尿道长度无显著性差异(P>0.05);4cm组输出道均出现漏尿,8cm组则因输出道于腹直肌内断裂、缺血坏死致管腔封闭、严重纤维化并扭曲成角等原因而未达到可控性。结论适当长度的不经隧道包埋而直接与膀胱吻合的小口径回肠输出道在腹直肌的加强支持下可以获得满意的控尿能力。
Objective To study the restraining capability mechanism of small calibre ileum conduit anastomosed directly to the bladder in pigs. Methods 15 pigs were randomized into 5 groups according to the length of the ileal loop to form the conduit;4cm, 5cm, 6cm, 7cm, and 8cm. In each pig, two ileal segments of the same length were reduced in calibre by opening up longitudinally and closed around a catheter. They were then directly anastomosed to the bladder end to side and placed within rectus abdominis musche in each pig. Urodynarnic test, radiological image analysis and histological study were carried out 8 weeks after the procedure. Results No stenosis and twisting of the ileal ileum conduit were observed in 5cm, 6cm, and 7cm groups, in which they could be catheterized with ease. When the bladder was filled with a mean volume of 400ml of saline, the maximum ＂urethral＂ pressure ranged from 5. 15-12. 19kPa and the maximum close pressure （MCP） ranged from 4.83-11. 27kPa. The ＂urethral functional length＂ of the ileal conduit was longer than 2cm. Among 5cm, 6cm and 7cm groups, there were no significant differences in maximum closure pressure and the urethral functional length, except in maximum ＂urethral＂ pressure. In the 4cm group, there was incontinence. Failure was found in the 8cm group because of necrosis of the ileal loop embedded in the abdominal muscle. Conclusion Small calibre conduits formed with ileum in the length of 5cm to 7cm are able to restrain urinary leakage when anastomosed directly to the bladder and and embedded in the by rectus abdominis in pigs.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2006年第6期559-560,共2页
Medical Journal of Chinese People's Liberation Army
关键词
尿流改道术
回肠
可控性
urinary diversion
ileum
continence
