阑尾原位脐部造口的可控性回结肠膀胱术

Ileocolonic pouch with appendix in situ through umbilicus as a continent conduit

目的尝试根据Ｍｉｔｒｏｆａｎｏｆ原理，将阑尾不加任何处理直接从脐孔穿出，构成可控性回结肠膀胱的排出管道。方法选取末段回肠和盲肠升结肠各约２０ｃｍ，保留阑尾。沿肠系膜对侧缘纵行劈开肠管，远近端对折缝合形成囊袋。双侧输尿管与囊袋以粘膜下隧道法吻合，阑尾末端开放，并直接从脐部戳孔引出固定，形成可控性回结肠膀胱。结果８例患者术后随访１０～３０个月，回结肠膀胱脐部阑尾排出道控尿能力满意，患者自行插管排尿方便容易，平均每次导尿量３００～５００ｍｌ，回结肠膀胱内压２０～４５ｃｍＨ２Ｏ（１．９６～４．４１ｋＰａ），无输尿管返流或积水及其它明显并发症。结论不加任何处理的阑尾原位脐部造口的可控性回结肠膀胱术，手术简便，控尿可靠，自我插管方便，为膀胱全切除术后尿流改道患者提供了较为理想的生活质量。

Objective To try to use appendix in situ without any special treatment as a conduit of the continent cutaneous ileocolonic reservoir.Methods An isolated ileocolonic segment, about 20 cm of terminal ileum and 20 cm of ascending colon, was detubularized by antimensenteric splitting and a pouch was completed by side to side anastomosis of the colon and the ileum loop.Both ureters were implanted into two separate submucosal tunnels of 3cm long into the colon wall of the pouch.The appendix after tail was amputated was passed through the umbilicus hole with which the base of the cecum was sutured.Results As a conduit of the pouch, the appendix had a good continent ability when 8 patients were followed up for 10 to 30 months after operation. It was easy and convenient for the patients to make self catheterization. The mean capacities of the pouch were 500～700ml and then the pressures were 20～45 cm H 2O while it was filled. There were no definite complications such as urine leakage, stoma stenosis, ureter reflux, and hydroureteronephrosis.Conclusion The operation of the ileocolonic pouch with the appendix as a continent umbilical stoma is simple and easy to perform and has such advantages as good continent, convenient self catheterization and provides a quality life for the patients undergoing total cystectomy.