摘要
目的：探讨根治性全膀胱切除术术后尿流复道关键技术的设计以及适应证的选择。方法：我们对1例行根治性全膀胱切除＋回肠膀胱术后患者施行回肠＋乙状结肠原位新膀胱术以实现尿流复道，术前准备主要包括患者心理准备、肿瘤预后的相关检查和尿道括约肌功能判断。金属尿道探子支撑下分离尿道残端以备用。选取乙状结肠20cm纵行剖开形成肠袋，作为新膀胱的“u”部分。切除Bricker腹壁造瘘口，并以此段回肠形成半套叠状抗反流结构及新膀胱的“T”部分。“T”肠袋与“u”肠袋侧一侧吻合，共同形成“Tu—Pouch”新膀胱。新膀胱最低点与尿道残端吻合。结果：术后随访1年，患者自行排尿通畅，尿量350～400ml／次，日间排尿3～5次，控尿良好；夜间排尿2～3次，轻度尿失禁。逆行膀胱造影未见造影剂向输尿管反流，静脉肾盂造影见双侧。肾盂输尿管显影良好，无积水。结论：全膀胱切除术后的尿流复道手术是复杂的、高难度和高风险手术，需严格掌握适应证。有效的抗反流机制和良好的控尿功能是决定手术是否成功、影响患者术后生活质量的关键。
Objective： To investigate the design of key technologies and indications of urinary undiversion after radical cystectomy. Method： One case diagnosed of postoperative radical cystectomy and ileal conduit were suc- cessfully performed ileum and sigmoid orthotopic neohladder. Psychological preparation, the prognostic Check of carcinoma and urethral sphincter function judgment were included in preoperative preparation. Surgical procedures were as follows： separating urethral stump, selecting sigmoid 20 cm, cutting it from the vertical line to form the intestinal bags, resecting abdominal stoma and free ileum of Bricker to create anti-reflux mechanism, making it an- astomosis with sigmoid intestinal bag side-side to form a new bladder. Result： After one-year follow-up period, the patient could void voluntarily with a good stream. Complete continence was achieved during daytime, hut mild in- continence took place at night. Nocturia is 2-3 times per night. Bladder capacity is about 400 ml and retrograde cystography showed no contrast agent refluxed to ureter. IVU showed normal morphology and no hydronephrosis could be seen in bilateral ureter and kidney pelvis. Conclusion： Urinary undiversion surgery is complex, difficult and high-risk, thus indications should be strictly chosen. Effective anti-reflux mechanism and normal urinary func- tion are keys to determining whether the operation is successful and whether the operation affects the quality of pa- tients life.
出处
《临床泌尿外科杂志》
2014年第1期33-35,38,共4页
Journal of Clinical Urology
基金
清华-周大福医学研究专项基金(编号202836019-04)
清华-裕元医学科学研究基金(编号20240000538)
