膀胱憩室的手术治疗

Operative Teatment of Vesical Diverticula

作者总结３１例膀胱憩室的手术治疗结果，并介绍一种处理巨大膀胱憩室的简易手术。多数憩室继发于膀胱流出道梗阻。憩室内并发肿瘤７例，结石形成９例。膀胱憩室多由膀胱造影或Ｂ超诊断。憩室切除常采用膀胱内外联合入路。本组２６例手术同时处理膀胱出口梗阻和膀胱憩室。获得随访的２３例中，２１例尿路症状消失。７例憩室肿瘤患者中，５例在两年半内死亡，余２例分别存活２年和６年。本组２例巨大膀胱憩室行经膀胱内憩室旷置术，无并发症，膀胱造影无异常。作者认为，膀胱憩室的治疗应依据每个患者的情况而选用不同的手术方式。对位于膀胱后下方，粘连广泛的巨大憩室，宜采用经膀胱内入路憩室旷置术。

We reviewed the results of operative management of 31 patients with vesical deverticula,and introduce a simple technique for treating large bladder diverticula.In the 31 patients with vesical diverticula analysed, 23 were followed up for at least six months.Of the 31 patients, 25 were male and 6 female. The average age was 54 2 years. Diverticula was secondary to bladderoutlet obstruction.Seven cases had intradiverticular tumors,and 9 stones in the sac.The diagnosis of vesical diverticula was usually made by cystogram or ultrasonography. The operative indications for vesical diverticula included stone formation, intradiverticular tumor, ureteral obstruction,incomplete empting diverticulum and urine retention due to large diverticula.The combined extravesical and intravesical method was often used. 26 patients underwent both operations for outlet obstruction and vesical diverticula at the same time.Of the 23 followed up cases, 21 had no symptoms of the urinary tract.Five of the 7 patients with intradiverticular tumor died within 2 5 years; one of the rest survived for 2 years, and the others for 6 years. Two patients with large vesical diverticula received intravesical separation of diverticula. No complications encountered in this simple, time saving and safe procedure. Cystograms revealed normal condition.The choice of operative techniques to treat vesical diverticula varies with each individual patient.The technique of intravesical separation of vesical diverticula is suitable for large, adhesive and posterior diverticula.