改良Sigma直肠膀胱术14例临床分析

Analysis of 14 Cases Pertermed by Modified Sigma Ureterosigmoidostomy

目的 :介绍并评价改良 Sigma手术的可控性尿流改道临床疗效。方法 :14例膀胱、前列腺肿瘤患者接受该手术。取 2 5cm左右乙状结肠折叠后全层切开 ,再缝合成低压袋 ,低压袋顶端固定在骶岬处 ,两输尿管末端合并吻合并外翻形成乳头 ,从低压袋上方引入再植。结果 :术后发生直肠阴道瘘 1例 ,经横结肠造口过渡后自愈 ;1例左肾积水伴上尿路感染 ,经输尿管顺行扩张后恢复正常 ,该患者术后 3个月发生严重低血钾 ,经补充枸橼酸钾后治愈。平均随访 2 2 .5个月 ,本组未见尿失禁、上尿路感染。 3例肿瘤复发 ,2例肉瘤复发患者于术后 6个月后死亡。结论 :改良 Sigma手术费时短 ,对肠管扰动小 ,操作简便 ,术后尿控满意 ,无上尿路积水、感染及明显酸碱电解质紊乱 ,明显提高了患者生活质量。

Objective[WT5,5”BZ]:To introduce the operation procedure and assess the continent diversion results of modified ureterosigmoidostomy after radical cystectomy. Methods:Fourteen cases with bladder neoplasm or prostate neoplasm were given modified Sigma pouch from Feb, 1998 to Dec, 1999. Folded and made a longitudinal incision about 25 cm on the sigmoid wall and then sutured the incision to form a low pressure pouch. The vertext of new pouch was fixed to sacrum. New modified tehnique that both ends of ureters were combined anastomosis together to form a bigger nipple and then place it into the top of the pouch about 2 centimenters was applied. Results:About sixty five minutes was spent to finish a new lowpressure pouch after radical cystectomy. Early complication occured in two cases postoperatively. Rectovaginal fistula was cured by temporary colonstomy. Hydronephrosis and hypokalemia in another patients was cured by percutaneous anterograde ureter dilatation and oral replacement of potassium salt. All patients were uriuary continent. No sympotomatic renal infection or hypercholoraemic acidosis occurd. During following up tumor recured in 3 cases. Two cases died of sarcoma after 6 monthes postoperatively. Conclusions:Modified ureterosigmoidostomy is a safe method of urinary diversion and provides a high volume, low intravesical pressure pouch. The patients could be free from troublesome of urine bag or interrupted catheterization, and the upper urinary tracts were prectected effectively. These cases′ life quality was improved. [