摘要
目的探讨膀胱全切后双输尿管一侧汇合皮肤造口术进行尿流改道的临床疗效。方法回顾分析膀胱全切术后双输尿管一侧汇合皮肤造口术32例的临床资料。主要技术包括:①左右输尿管均游离至肠系膜下动脉分叉附近,于腹主动脉表面穿过后腹膜转到腹腔;②左右输尿管汇合后,远端纵行剖开约6cm,侧-侧吻合3.54cm,留末端22.5cm皮肤造口用;③皮肤造口在右侧标准腹壁造口部位,采用3角缝合固定法;④输尿管末端与皮肤的造口吻合采用双"V"形皮瓣嵌入双输尿管瓣之间成形术;⑤左右双"J"的留置大于2月后拔除。结果所有病例获随访,平均为(22.3±8.1)个月,并发症总发生率为12.5%,粘连性肠梗阻1例,上尿路积水2例,逆行感染1例。结论双输尿管一侧汇合皮肤造口术手术时间短、创伤小、易操作,不涉及肠道、术后并发症率低,是值得推广的一种尿液改道术。
ObjectiveTo investigate the treatment of urinary diversion with modified cutaneous ureterostomy technique for adults with radical cystectomy. Methods A total of 32 patients underwent modified cutaneous ureterostomy for urinary diversion. The technique included：①the left and right ureters were transpositioned above the inferior mesenteric artery, and mobilized to abdominal aorta; ②6 cm lateral spatulation with lateraltolateral anastomosis was created on both ureters （3.5~4 cm）; ③hiatus was fixed with 3 angle suture on the abdominal wall; ④a skin stoma was created with doubleV skin flap and lateral spatulation of each terminal ureter for 25 cm with technique of edgetoedge anastomosis; ⑤doubleJ stents were removed 2 months later. Results All cases were followed up for 22.3（2~103） months. The rate of surgical complications was 12.5%, including 1 case of adhensive intestinal obstruction, 2 cases of hydrops of upper urinary tract and 1 case of retrograde infection. Conclusion The modified cutaneous ureterostomy has advantages of short operation time, few trauma, few complications and simple procedure.
出处
《现代泌尿外科杂志》
CAS
2013年第5期478-480,489,共4页
Journal of Modern Urology
关键词
膀胱肿瘤
膀胱全切术
尿流改道术
输尿管皮肤造口术
并发症
bladder neoplasm
radical cystectomy
urinary diversion
cutaneous ureterostomy
surgical complication
