“插入式”输尿管肠管吻合在原位肠道膀胱替代术中的应用

The use of ＂inserting＂ uretero-intestinal anastomosis in orthotopic bladder substitution

目的探讨“插入式”输尿管肠管吻合在原位肠道膀胱替代术中的手术效果和临床疗效。方法对38例原位肠道膀胱替代术中75侧行“插入式”输尿管肠管吻合术患者进行随访，通过影像学、膀胱尿道镜、病理学、实验室检查等观察临床疗效。结果术后平均随访（31．65±14．14）个月，吻合口狭窄率4％（3／75）；抗返流率100％；无吻合口漏；膀胱尿道镜下，输尿管种植部位形成乳头，钳取7例患者乳头表面小块上皮组织作病理检查，其中乳头基底部2例为肠黏膜上皮，乳头尖端5例为移行上皮；所有患者复查肾功能均在正常范围，血Cr54～135μmol／L，BUN3．2～9．4mmol／L。结论“插入式”输尿管肠管吻合术是一种较理想的输尿管肠管抗返流吻合术式。

Objective To analyse the operation technique and therapeutic effect of ＂inserting＂ uretero-intestinal anastomosis in orthotopic bladder substitution. Methods Thirty-eight patients undergoing orthotopic bladder substitution operations were followed up, and the way of uretero-intestinal anastomosis in all patients was the ＂inserting＂ uretero-intestinal anastomosis. The therapeutic effect was observed by radiation,cystoscopy,pathologic biopsy and blood test. Results The average follow-up time was （31.65±14.14 ） months, and the stricture rate was 4%（3/75 ）, but no vesicoureteric reflux was found. The rate of leakage was 0. Nipples were formed at the site of anastomosis under the view of cystoscope, and among the 7 patients whose nipples were taken to be examined by histology, 2 cases were intestinal epithelium which were taken at the base of nipples, while the others were transitional epithelium which were taken at the top of nipples. The renal function of all patients was normal （Cr 54-135 μmol/L,BUN 3.2-9.4 mmol/L）. Conclusion ＂Inserting＂ uretero-intestinal anastomosis is an ideal antireflux uretero-intestinal anastomosis method.