输尿管末端蹼状与膀胱吻合术的观察

Observation on Effect of Web-ureterocystostomy

目的 探讨输尿管末端蹼状膀胱吻合术与传统术式Politano -Leadbetter法 (隧道式输尿管膀胱吻合术 )的优缺点。方法 采用输尿管末端蹼状膀胱吻合术 4 0例与隧道式输尿管膀胱吻合术 38例进行对照 ,方法是将输尿管末端近膀胱侧纵行切开 1.0cm ,输尿管末端成三角形 ,修剪三角形的角使输尿管末端呈蹼状 ,然后行输尿管末端蹼状与膀胱吻合 ,将输尿管末端包埋于膀胱壁内形成抗返流装置。结果 观察组尿瘘发生明显减少(P <0 .0 1) ,肾积水发生率明显降低 (P <0 .0 5 ) ,术后膀胱刺激症状发生率明显减少 (P <0 .0 1) ,输尿管返流率无明显差异 (P >0 .0 5 )。结论 输尿管末端蹼状膀胱吻合术 ,具有操作简便 ,吻合口吻合牢固 ,抗输尿管返流效果确切 ,且具有在膀胱腔外即可完成吻合的优点 ,可作为输尿管与膀胱吻合常用的手术方法 。

Objective To evaluate the advantage and disadvantage of Web-ureterocystostomy against Tunnel-ureterocystostomy.Methods Web-ureterocystostomy was performed in forty cases and Tunnel-ureterocystostomy was performed in thirty-eight cases.In the former group,the patients underwent the operation procedure as follows:longitudinally cut 1.0cm of the ureter end at its inner by embedding it into the bladder wall to form an anti-flux device.Results A remarkable decrease of uric fistula rate(P<0.01),hydronephrosis rate(P<0.05),and bladder stimulation syndrome(P<0.01) were observed respectively in Web-ureterocystostomy cases.Nevertheless,little difference was present in Ureteral reflux rate(P>0.05) in the two groups.Conclusions Web-ureterocystostomy is superior to Tunnel-ureterocystostomy in the way that the operation procedure is simpler and the anastomosis is more reliable.Therefore,it can be a good choice for the anastomosis of ureter and bladder,especially in the cases of ureteral end disease and allogenetic renal transplantation.