浆膜间隧道技术在尿路重建中的临床应用

Serous-lined tunnel technique in urinary reconstruction

目的 评价浆膜问隧道技术在原位膀胱、可控尿流改道和回肠代输尿管成形术中的临床应用效果. 方法浆膜间隧道技术是将重建输出道或再植输尿管置于储尿囊的回肠壁浆膜之间以达到可控或者抗反流的目的 .应用浆膜间隧道技术在原位回肠膀胱重建患者中行输尿管再植31例,可控回肠膀胱重建患者中行可控瓣成形和输尿管再植13例,回肠代输尿管成形患者中在输尿管近端应用该技术抗反流3例. 结果平均随访27（12～132）个月.88根植入回肠新膀胱或可控膀胱的输尿管功能良好,造影显示无梗阻或反流,13例可控瓣12例无漏尿,3例回肠输尿管成形患者造影均无回肠输尿管反流,IVU显示肾积水较前明显好转. 结论应用浆膜问隧道技术进行输尿管再植和可控瓣成形临床效果良好,可以作为尿路重建中的常规应用.

Objective To examine the feasibility of using the serous-lined tunnel technique for orthotopic neobladder, continent cutaneous diversion and ureteral replacement by the intestinal segment. Methods In 31 patients of orthotopic ileal neobladder, the serous-lined tunnel techniques were used for antirefluxing ureteral implantation： In 13 patients of continent ileal pouch, the techniques were adopted for continent-valve construction and for uretersl implantation： In 3 patients （with lower ureteric cancer）, the same techniques were applied for constructing the ileal ureters with a proximal antirefluxing mechanism. Results With a mean follow-up of 27 mon（ 12-132 mon）, 88 ureters implanted into ileal neobladders or continent pouches functioned well with neither obstruction nor reflux： 12 in 13 continent valves functioned well with no incontinence. 3 patients with ileal ureters showed no ileo-ureteric reflux and had reduced hydronephrosis comparing to that of before surgery.Conclusions Ureteral reimplantation and continent valve formation achieved by adopting the serouslined tunnel technique provide satisfactory results. The versatility of the technique is obvious in the present experience and the creative application of the serous-lined tunnel technique should be possible in urinary reconstruction.