阑尾原位脐部造口的回结肠膀胱术

Ileocolic Pouch with Appendix in Situ Through Umbilicus as a Continent Conduit

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１５ｃｍ和盲肠升结肠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水能力满意，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１９６１４～４４１３２Ｐａ，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回结肠膀胱术，手术简便，控尿可靠，自我插管方便。

Objectives:To try to use appendix in situ without any special treatment as a conduit of the continent cutaneous ileocolic reservoir. Methods: An isolated ileocecal segment,about 15 cm of terminal ileum and 20 cm of ascending colon,is detubularized by antimensenteric splitting and a pouch is completed by side-to-side anastomosis of the colon and the ileum loop.Both ureters are implanted into two separate submucosal tunnels of 3 cm length into the colon wall of the pouch.The appendix after cut the tail is passed through the umbilicus hole with which the base of the cecum is sutured. Results: As a conduit of the pouch,the appendix has a good continent ability when 21 patients were followed-up 10 to 30 months after operation.It is fairly easy and convenient for the patients to make selfcatheterization.The mean capacity of the pouch is 500 mL and the pressure is 40 cm H 2O while it is filled.There are no definite complications such as ureter reflux and hydroureteronephrosis. Conclusion: The operation of establishing an ileocecal pouch with the appendix as a continent stoma is simple,easy and having the advantages of satisfactory continent,convenient self-catheterization and rendering the patient udergoing total cystectomy a quality life.