输尿管皮肤造口在膀胱全切除术中的应用

The application of cutaneous ureterostomy in bladder resection

目的:探讨根治性膀胱全切输尿管皮肤造口治疗复发性或浸润性膀胱癌的手术适应证及治疗效果。方法:采用双输尿管并行右下腹壁造口术式,即将左侧输尿管于骶前经乙状结肠腹膜后转移至右侧与该侧输尿管一并引出腹壁,形成双乳头,输尿管内各置入支架管1根,外接集尿袋。治疗12例复发性或浸润性膀胱癌。结果:术后尿液引流通畅,无手术死亡及严重并发症。随访2个月至1.5年,无乳头缺血、坏死及内陷,无肾盂肾炎。外口狭窄2例,均经斑马导丝引导下重新置入单J管支撑后引流恢复通畅。经大剂量静脉肾盂造影、B超检查,双肾无明显积水。结论:该手术操作简单、安全,并发症少,成功率高,特别适合晚期膀胱癌、全身情况差、老年及不宜行复杂手术的高危患者。

Objective：To discuss the effect of cutaneous ureterostomy on invasive or recurrent bladder cancer.Methods：Bilateral cutaneous ureterostomy combined with abdominal stoma on the lower right,was performed in 12 patients with invasive or recurrent bladder cancer.Results：In all patients,the drainage of urine was unobstructed,and no death case or severe complication appeared.After a follow up of 2 months to 1.5 years,there were no postoperative complications such as renal papillary ischemia,necrosis,and invagination in all cases.Conclusions：Cutaneous ureterostomy is simple and safe treatment,and particularly suitable for the old and weak patients with advanced bladder cancer.