缩窄末段回肠式可控性膀胱术

Thepostoperativeeffectsoftaperedterminalilealcontinenturinaryreservoir

作者报告２３例缩窄末段回肠式可控性膀胱术的术后疗效。采用缝合器裁剪缩窄末段回肠形成输出道，回结肠或结肠剖开后重组成腔形成贮尿囊，输尿管末段插入贮尿囊作吻合。２２例随访１～６年，其中回结肠贮尿囊１３例，结肠贮尿囊９例。全部病例抗失禁效果良好，除１例发生插管困难外，均能用较粗的导尿管自行导尿。术后１年时，回结肠贮尿囊容量为９００ｍｌ～１０００ｍｌ，充盈压０．４９ｋＰａ～１．９６ｋＰａ，收缩波峰１．９６ｋＰａ～２．７４ｋＰａ；结肠贮尿囊容量为４００ｍｌ～５００ｍｌ，充盈压０．９８ｋＰａ～１．９６ｋＰａ，收缩波峰１．９６ｋＰａ～３．９３ｋＰａ。随访期间发现贮尿囊过度扩张６例，结石２例，感染１２例次。未见输尿管梗阻、返流及明显的高氯性酸中毒等并发症。结果表明：缩窄末段回肠式输出道抗失禁效果好，插管导尿顺利。重组成形后，结肠贮尿囊和回结肠贮尿囊均能获得低囊内压，应注意防治贮尿囊过度扩张、结石及感染等并发症。

Wereportpostoperativeefectsof23caseshavingtaperdterminalilealcontinenturinaryreservoirisreported.Theoperativetechniquewascharacterizedbytaperingtheterminalileumwithsta-plertoformacontinenteferenttract,segmentsofintestinewerecutopenandreformedapouch,andtheureterimplantationwasperformedbymeansofinsertingtheendofuretersintothepouch.Ileo-colonicpouchwesconstructedfor14patientsandcolonicpouchfor9patients.22patientswerefol-lowedupfor1to6yearsexceptonediedofcerebralhemorhage2weeksafteroperation.Urineconti-nencewereachievedinalpatientsandselfcatheterizationcouldbeeasilyundertakenwith20F～22Fcatheterin21.Dificultyincatheterizationwashappenedinoneearlycase.Oneyearafteroperation,themaximumvolumeoftheileocolonicpouchwas900ml～1000ml.Thebasalandintermitentpressureofthefilingpouchwas0.49kPa～1.96kParespectively.Themaximumvolumeofthecolonicpouchwas400ml～500ml.Thebasalandintermitentpresureofthefilingpouchofthecolonicpouchwas0.98kPa～1.96kPaand1.96kPa～3.93kParespectively.Thecomplicationofpouchoverdistentionwasfoundin6cases,pouchstoneformationin2andpouchinfectionin12episodes.Therewasnoevidenceofureteralobstructionorrefluxandsignificanthyperchloricacidosis.Itisrecognizedthattaperedtermi-nalileumisagoodwaytoconstructacontinenteferenttract,bothileocolonicpouchandcolonicpouchcanmeettheneedoflowinnerpouchpressuresolongastheintestineswerecutopenandreformed,andefortsmustbemadetopreventthecomplicationsofpouchoverdistension,stoneformationandpouchinfection.