采用回肠纵行折叠抗反流抗失禁行可控性回肠膀胱术(附24例报告)

Application of Longitudinal Folding of the Concerned Ileal Segment for Anti－reflux and Anti－incontinence Constructs a Continent Ileal Reservoir

目的：简化及改良可控性回肠膀胱术。方法：自1995年8月至1999年8月采用回肠纵行折叠抗反流及抗失禁代替肠套叠乳头瓣抗反流及抗失禁共完成可控性回肠膀胱术24例。结果：24例随访4～48个月，23例效果满意，白天平均4小时导尿1次，夜间导尿 0～2次，插管顺利，无漏尿现象。贮尿囊容量320～560ml，贮尿囊最大充盈压10～22cmH_2O。1例因贮尿囊粘连，储尿量小。全部病例无输尿管返流及电解质、酸碱平衡紊乱，肾功能正常。结论：该手术方法相对简化，并发症少，可适用于临床。

Objective: To simplify and modify the surgical technique in construction of a continent ileal reservoir． Methods: A modified continent ileal reservoir was carried out from August 1995 to August 1999 after total cystectomy in 24 cases． The key technique was the substitution of a longitudinal folding of the concerned ileal segment for intussuscepted nipple valve for anti－reflux and anti－incontinence． Results: Twenty－four patients were followed up for 4～48 months． Twenty－three cases achieved satisfactory efficacy． The mean interval of self－catheterization was 4 hours with a urine volume about 320ml～560ml． The maximal filling pressure of reservoir has been 10cmH_2O～22cmH_2O． Renal function has been normal in all patients without electrolyte disturbance． Conclusion: This surgical technique is simple and is recommended for clinical application．