改良Mainz Pouch Ⅱ尿流改道术的临床应用

Clinical Application of Modified Mainz Pouch Ⅱ Urinary Diversion

目的探讨膀胱全切术后改良MainzpouchⅡ尿流改道术的临床应用价值。方法回顾性总结18例膀胱癌患者实施膀胱全切后采用改良MainzPouchⅡ尿流改道术的临床资料。结果本组尿流改道时间平均130（110—140）min，术中出血量平均383（200—800）ml，术后住院时间平均19．1（7—30）d。围手术期因多器官功能衰竭死亡1例（5．6％）。术后早期（1个月内）并发症发生率为44．4％（8／18），包括切口感染5例，切口裂开2例，延迟性肠梗阻1例，无尿瘘及肠瘘。远期（1个月后）并发症发生率为41．2％（7／17），包括肾盂肾炎1例，输尿管肠吻合口狭窄致单侧肾积水1例，持续非梗阻性腹痛1例；肾功能损害1例；代谢性酸中毒需长期服用碱剂者3例，其中需住院治疗者1例。白天控尿率100％，夜间控尿率1个月内为82．3％（14／17），1个月后达100％。排尿次数：术后1个月内白天6～8次，夜间3—5次，1个月后白天4—6次，夜间0—3次。病人对排尿和控尿评价“非常好”占29．4％（5／17），评价“好”占64．7％（11／17），评价“差”占5．9％（1／17），满意率达94．1％（16／17）。结论改良MainzPouchII尿流改道术操作简单、安全，临床疗效肯定，是目前较为理想的尿流改道替代方式。

Objective To explore the clinical application value of modified Mainz pouch Ⅱ urinary di- version after radical cystectomy. Method A total of 18 bladder cancer patients who underwent a reconstruc- tion of the Mainz pouch ]] urinary diversion after radical cystectomy were analyzed retrospectively. Results The average time of urinary diversion was 130 minutes （ranged 110 to 140 minutes）, the average intra-opera- tive blood loss was 383 ml （ranged from 700 to 800 ml）, and the average post-operative hospital stays were 19.1 days （ranged from 7 to 30 days）. One case died of muhiple organ failure during the perioperative peri- od. The early postoperative complication rate （within 1 month of surgeon） was 44.4% （8/18） , including postoperative infection in 5 cases, disruption of wound in 2 cases and delay intestinal obstruction in 1 case. The long-term complication rate was 41.2% （7/17）, including pyelonephritis in 1 case, unilateral hydrone- phrosis associated with ureter-intestinal anastomosis stenosis in 1 case, continuing non-obstructive abdominal pain in 1 case, renal functional lesion in 1 case and metabolic acidosis in 3 cases. The urinary continence rate during the day was 100%, and that during the night was 82.3% within 1 month and 100% one month after the operation. The patient＇s satisfaction with the diversion and the overall quality of life was described as very good in 29.4%, good in 64.7% and poor in 5.9% respectively, and the satisfied rate was 94.1%.Conclusions Themodified Mainz pouch Ⅱ urinary diversion is a simple and safe procedure with positive effect as low complication rate, good urinary continence and well quality of life. It is an ideal alternative procedure of continent urinary diversion.