升结肠在尿流改道中的应用

Applicability of ascending colon for continent urinary diversion

目的 评估升结肠在尿流改道中应用的疗效和安全性。方法 对68例全膀胱切除患者取用升结肠分别施行可控性回结肠膀胱术(42例)和升结肠原位膀胱术(26例),并随访3～96个月。结果 膀胱肿瘤患者术后无局部复发.原位新膀胱组后尿道无肿瘤生长。两种术式贮尿囊造影均无输尿管反流,无肾积水,肾功能无恶化。术后6个月尿动力学检查,可控性回结肠膀胱术和升结肠原位膀胱术平均贮尿囊最大充盈压分别为3.2 kPa和2.4 kPa,平均容量分别为380 mL和420 mL;可控性回结肠膀胱术平均输出道最大压力为10.9 kPa,原位膀胱术平均后尿道最大压为8.01 kPa.平均最大尿流率17.6 mL/s。结论 取用升结肠建立的贮尿囊具有容量大、内压低、无反流、无代谢紊乱等优点。两种手术方式均可自由控制排尿,提高生活质量。

Objective To appraise the applicability of the ascending colon for continent urinary diversion. Methods Sixty-eight patients after total cystectomy were followed from 3 to 96 months. Among them a modified Indiana pouch was constructed in 42 patients and an orthotopic neo-bladder was treated the from the detubularized ascending colon in 26 patients. Results There was no local tumor regrowth at the posterior urethra in patients with an orthotopic neo-bladder. In the Indiana pouch group, there was no leakage and only one case of catheterization difficulty resolved with minor plastic surgery. In those with later IVU checkups, neither hydronephrosis nor renal function deterioration was observed. Six months post-operatively, the mean maximum filling pressure in both groups 3.2 kPa and 2.4 kPa, and the mean maximum volume 380 mL and 420 mL, respectively. The mean maximum conduit pressure for the Indiana pouch was 10. 9 kPa and mean maximum posterior urethrul pressure for the orthotopic neo-bladder was 8.01 kPa . Interestingly, a mean maximum urinary flow rate of 17.6 mL/s was obtained for the orthotopic neo-bladder. Conclusion Urinary reservoir derived from the detubularized ascending colon possessed the advantages of larger volume, lower intervesical pressure, no reflux and no metabolic disturbances. Both forms of construction provide satisfactory continent and controllable urinary diversion, and thus greatly improve life quality.