可控性膀胱术后远期并发症及其防治

Late complications of continent urinary reservoir

为探讨可控性膀胱术后晚期并发症的防治办法，分析了２５例术后的随访结果。１９８８年５月至１９９４年６月，我院共施行了膀胱全切除可控性膀胱术２６例，其中２５例随访了１～７年，随访期间发现的晚期并发症有：贮尿囊过度扩张８例，贮尿囊结石３例，尿失禁２例，导尿困难３例，肾盂输尿管轻度扩张３例，轻度高氯性酸中毒３例，腹泻１例。通过对这些并发症的处理及原因分析，我们认为贮尿囊过度扩张是贮尿囊结石、感染和代谢紊乱的原因之一，缩窄末段回肠式输出道控尿良好，并发症少，明显优于套叠乳头式输出道；抗返流输尿管吻合及低压贮尿囊是保护肾功能的关键。

From May l988 to June l994, continent urinary reservoir was constructed after total cystectomy for 26 consecutive patients. 25 of which have been followed up for l～7years. Urinary pouch overdistention has been observed in 8, stone formation in the pouch in 3, urinary incontinence in 2,difficulty with catheterization in 3,mild hyperchloremic acidosis in 3 and diarrhea in l.Pouch overdistention was believed to be the main cause of the above-stated complications.The tapled terminal ileum for the construction of a continent urinary reservoir has been better with less complications than the intussusepted ileal valve. The key points of the surgical procedure were the antireflux anastomosis of ureters and the construction of a low pressure pouch, both being important in the protection of renal function.