以阑尾为流出道的可控性回盲肠膀胱术远期疗效观察

Long-term follow-up of the appendix as outlet of ileocecum-colon continent re servoir

目的 评价以阑尾为流出道的可控性回盲肠膀胱手术的远期疗效。 方法 应用回盲肠及部分升结肠作储尿囊 ,以阑尾为流出道腹壁造口术治疗膀胱肿瘤患者 4 6例 ,采用尿动力学方法随访 5年以上 2 1例。男 15例 ,女 6例 ,平均年龄 5 7岁。G2 12例 ,G3 9例。T3aN0 M0 11例 ,T3bN0 M05例 ,T3bN1M0 3例 ,T3bN0 M0 2例。 结果 2 1例患者中能控尿者 19例 (95 % )。白天导尿 4～ 5次 ,夜间 1～ 2次 ,每次量 2 5 0～ 4 0 0ml。膀胱初始感觉压力平均 2 8cmH2 O ,最大充盈压 36cmH2 O ,储尿囊容量分别为 2 6 5ml、4 5 0ml。阑尾流出道闭合压力 4 5cmH2 O。 1例患者出现肺转移行手术切除 ,1例出现肝转移死亡。无输尿管返流 ,无高氯血性酸中毒。 结论 以阑尾为流出道的回盲肠膀胱术储尿囊内压低、容量大、可控性好 ,是一种较理想的尿流改道方式。

Objective To evaluate the long-term effe ct of the continent urinary reservoir of ileocecum-colon with the appendix as out let. Methods Continent urinary reservoir of ileocecum-c olon with the appendix as outlet was performed in 46 patients with bladder tumor .Of them,21 patients (15 men and 6 women;mean age,57 years) were followed up by urodynamics for over 5 years.Pathologic grading showed G 2 in 12 cases and G 3 in 9;TNM staging showed T 3aN 0M 0 in 11 cases,T 3bN 0M 0 in 5,T 3bN 1M 0 in 3 and T 3bN 0M 1 in 2. Results Of the 21 cases,19 (95%) were of urinary continence.Catheterization was perfor med 4～5 times at daytime and 1～2 times at night; the volume was about 250～400 ml each time.On average the initial pressure of the reservoir was 28 cm H 2O (1 c m H 2O=0.098 kPa),and the maximal filling pressure was 36 cm H 2O;the correspo nding average capacity of the reservoir was 265 ml and 450 ml,respectively.The c losing pressure of the appendix outlet was 45 cm H 2O.One case developed lung m etastasis and underwent resection; 1 developed liver metastasis and died later.N o evidence of ureteral reflux and no hyperchloremic acidosis were observed. Conclusions Continent ileocecum-appendix pouch can be consi dered as an ideal form of urinary diversion characterized by lower internal pres sure and larger capacity of the urinary reservoir, and satisfactory continence.