摘要
目的评价乙状结肠直肠储尿囊压力一容积变化及尿流率和上尿路功能。方法2007—2011年，行根治性膀胱切除术并乙状结肠直肠储尿囊术（Mainz pouch II）治疗肌层浸润性膀胱癌患者10例。输尿管植入≥30cm去管化乙状结肠后壁。术前行结肠镜检查并测定肛门括约肌张力，术后3～6个月行影像尿动力学检查和尿流率测定，IVU检查评价上尿路功能。结果乙状结肠A肠储尿囊平均容量360ml（270～532m1）时未产生反流。术后3～6个月，乙状结肠直肠压力平均为26cmH2O，肛门括约肌张力维持90emH2O。上尿路及肾功能保护良好。腹压排尿方式下平均Qmax为30ml／s，平均尿流率为8ml／s。术后最初2个月内有轻度尿失禁，第3个月开始逐渐达到控尿，夜尿次数1～4次。发生代谢性酸中毒1例，口服碳酸氢钠片及氯化钾缓释片后治愈。结论乙状结肠直肠储尿囊能够达到高容、低压，且无上尿路及降结肠反流；代谢性酸中毒发生率低；是一种能够保证良好上尿路功能和高生活质量的尿流改道方法。
Objective To measure the pressure-volume changes and uroflow rate, and assess the function of upper urinary tract in sigmoidorectal pouch patients. Methods Between 2007 and 2011, a total of 10 patients who had a radical cysteetomy because of muscle-invasive bladder tumor underwent a Mainz pouch II procedure were evaluated. The ureters were implanted into the post walls of the detubularized sigmold segment at least 30 em in length. In all cases, sigmoidoscopy was done and the anal pressure was measured preoperatively, and video urodynamic study of sigmoidorectal pouch as well as the intravenous pyelography was conducted after 3 to 6 months postoperatively. Results Video urodynamic study of sigmoidorectal pouch revealed that no reflux up to an average volume of 360 ml （270 -532 ml） of the descending colon. The sigmoidal colon pressure was 26 cm H^O during the 3 to 6 months post - operative follow-up. The anal sphincter pressure was 90 em H20 on average preoperatively and did not change postoperatively. The renal function and upper urinary tract were preserved well. The Qmax was 30 ml/s and the average uroflow rate was 8 ml/s under abdominal strain. All the patients suffered slight incontinence in the first two months and became continent since the 3 month postoperatively with nocturnal voiding one to four times. Conclusions The sigmoidorectal pouch provides a reservoir with a higher capacity, lower pressure without reflux to the upper urinary tract and descending colon and lower metabolic acidosis problem. It is also a good alternative diversion procedure that would preserve upper urinary tract and good quality of life.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2012年第9期682-684,共3页
Chinese Journal of Urology
