改良式乙状结肠代膀胱术的临床应用

Clinical application of modified the sigma-rectum pouch conduit for urinary diversion

目的:评价改良式乙状结肠代膀胱术的临床效果。方法:对15例行根治性膀胱全切术膀胱癌的患者,在原Mainz膀胱Ⅱ式手术基础上进行可控尿流术式,即改良式乙状结肠代膀胱术。结果:术后3个月随访,B超检查3例有单侧肾盂轻度扩张2cm,排尿稳定可控,最大容量400～600ml,5例电解质血CO2cp提示偏酸,肾功能均在正常范围。尿粪均完全分开,大便成形。结论:改良式乙状结肠代膀胱术简单易行,对肠道干扰小,在减少尿粪合流、逆行感染、代谢性酸中毒等方面效果明显,且适应证相对较广,是一种较好的可控性尿流改道方法。

Objective：To introduce the operation procedure and assess the clinical outcome of modified sigmoid colon pouch as a continent form of urinary diversion. Methods：The clinical data of 15 patients, 6 males and 9 fe males, aged 55.6（36-69） with muscle-invading bladder carcinoma who underwent a modified sigmoid colon pouch procedure after radical cystectomy 2003-2005 were analyzed. The intestine was incised over alength of 20 cm with the junction of sigmoid colon and rectum as the midpoint so as to create a low-pressure reservoir for urine and side-to-side anastomosis was performed on the posterior borders of the rectosigmoid wall. Submucosal tunnel technique was employed in antireflux urethral implantation, and both ends of ureters were to form a bigger nipple and then place it into the top of the pouch. Draw the input end of sigmoid colon into ampulla of rectum and interrupted suture. The vertext of new pouch was fixed to colon descendens. Results：The operations were successful and the total time was 160±40 min,bleeding 400±150 ml. The patients were followed up for 12-28 months with a mean of 20 months post operatively. After 3 months of theoperation continence has been achieved in all the 15 patients. The mean volume of pouch was 400-600 ml. Unilateral little hydronephrosis was found in 3 patients and light acidosis was found in 5 patient. No evidence of ureteral reflux was observed and renal function and electrolyte were normal. Conclusions： A modified sigmoid colon pouch procedure provides a reservoir with a higher capacity and lower pressure without a reflux to the upper urinary tract and descending colon with lower incidence of complication, it is also a better alternative diversion procedure that would be easily accepted by surgeons and patients.