摘要
目的 探讨腹腔镜回肠膀胱扩大术治疗低顺应性膀胱的有效性和安全性.方法 回顾性分析2011年6月至2013年12月浙江省人民医院泌尿外科收治的36例接受腹腔镜下回肠膀胱扩大术式治疗的高反射、低顺应性膀胱患者的资料.根据纳入排除标准共22例患者纳入本研究,其中男性13例,女性9例;年龄22 ～ 62岁,平均35.8岁.其中脊髓损伤15例,脊髓发育不良4例,泌尿系统结核3例.病程1 ～15年,平均8.5年.对术中、围手术期并发症进行观察评价,对术前、术后3、6、12、18、24、36个月患者的血肌酐水平、肾积水情况、肾小球滤过率及尿流动力学检查参数的比较采用单因变量多因素方差分析.结果 患者手术均在腹腔镜下顺利完成,手术时间90 ～ 150 min,平均（105±17） min,术中出血量60 ～ 150 ml,平均（90±26） ml,术后肠道功能恢复时间2～5d,平均（2.5±0.7）d,术后住院时间11 ～20 d,平均（15 ±4）d,术后均未发生回肠吻合口瘘、肠梗阻、严重腹腔感染或败血症等并发症.患者术后随访6 ～36个月,平均16.5个月,17例患者随访超过12个月.患者膀胱安全容量由术前的（103±38）ml增至术后末次随访的（405±46）ml （F=381.7,P=0.000）,膀胱顺应性由术前的（10±3）cmH2O（1 cmH2O=0.098 kPa）增至末次随访的（38±4）cmH2O（F=678.1,P=0.000）,末次随访时充盈期末膀胱内平均压力为（16±6） cmH2O,较术前的（45±16）cmH2O明显降低（F=221.5,P=0.000）,血肌酐水平从术前的（184±32） μmol/L降至末次随访的（120±28）μmol/L（F=189.1,P=0.000）,总肾小球滤过率从术前的（40±26）ml^-1·min^-1·1.73 m^-2升至末次随访的（66±32）ml^-1·min^-1· 1.73 m^-2（F=137.7,P=0.000）.3例泌尿系统结核膀胱挛缩患者的最大尿流率明显增加,残余尿量有所减少,另有4例女性患者术后恢复自行排尿.结论 腹腔镜下回肠膀胱扩大术治疗低顺应性膀胱安全可行,具有创伤小、出血量少、肠道功能恢复快、术后并发症较少等优点,可明显改善术后膀胱功能,有效改善和保护患者的上尿路功能.
Objective To study the effectiveness and safety of the laparoscopic ileal bladder augmentation treatment for low compliance bladder.Methods A retrospective analysis was performed based on 36 cases admitted to the Zhejiang Provincial People＇s Hospital with highly reflective and low compliance bladder accepted laparoscopic ileal bladder augmentation surgical treatment from June 2011 to December 2013.In accordance with inclusion and exclusion criteria,22 patients were enrolled in this study,including 13 males,9 females who aged from 22 to 62 years with an average of 35.8 years.Among the selected sample,there were 15 cases of spinal cord injury,4 cases of spinal cord dysplasia,and 3 cases of urinary tuberculosis.The duration of disease varied from 1 to 15 years,with an average of 8.5 years.For surgery,intraoperative and perioperative complications were observed,and preoperative serum creatinine in patients with postoperative at 3,6,12,18,24,36 months,hydronephrosis,and glomerular filtration rate urodynamic parameters were used for univariate analysis of variance.Results All patients were successfully completed in laparoscopic surgery,the operative time were （105 ± 17） minutes （90-150 minutes）,blood loss was （90±26）ml （60-150 ml）,postoperative intestinal function recovery time were （2.5±0.7） d（2-5d）,and postoperative hospital stay was （15.0 ± 4.2） d（11-20 d）,while postoperative anastomotic leakage,intestinal blockage,severe abdominal infection or sepsis and other complications did not occur.Patients were followed up for 6 to 36 months,with an average of 16.5 months,among which 17 patients were followed up for over 12 months.The bladder safety capacity increased from （103 ± 38）ml preoperatively to （405 ± 46） ml at the end of the follow-up（F =381.7,P =0.000）,and bladder compliance increased from （10 ±3）cmH2O（1 cmH2O =0.098 kPa） preoperatively to （38 ± 4） cmH2O （F =678.1,P=0.000）;the average pressure within the bladder filling at the end of the follow-up was （16 ± 6）cmH2O,which was significantly lower （F =221.5,P =0.000） compared to preoperative level of （45 ±16） cmH2O,preoperative serum creatinine went down from （184 ± 32） μmol/L to （120 ± 28） μmol/L at the end of the follow-up （F =189.1,P =0.000）;total glomerular filtration rate rose from （40 ± 26） ml^-1·min^-11.73 m^-2 preoperatively to （66±32）ml^-1·min^-11.73m^-2（F=137.7,P=0.000）.Qmax of the 3 cases of urinary bladder contracture tuberculosis patients increased significantly,while 4 female patients with residual urine volume decrease had voluntary urination.Conclusions Laparoscopic ileal bladder augmentation treatment for low compliance bladder is feasible and safe,with less trauma,less bleeding,less post-operative complications,and faster recovery of bowel function.Urinary function improves significantly after surgery,and function of upper urinary tract can also be effectively improved and protected in patients.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2015年第8期594-598,共5页
Chinese Journal of Surgery
关键词
腹腔镜检查
膀胱疾病
尿流改道术
尿动力学
Laparoscopy
Urinary bladder diseases
Urinary diversion
Urodynamics
