球形可控回肠贮尿袋代膀胱术研究及临床应用

REPLACEMENT OF THE BLADDER BY GLOBULAR CONTINENT ILEAL RESERVOIR

目的 :研制贮存尿液和排除尿液功能近似正常膀胱的原位膀胱重建术。方法 :取带系膜回肠段 30cm,乙醇浸泡肠粘膜 ,制成球形贮尿袋。输尿管与贮尿袋行抗返流吻合 ,贮尿袋下端与尿道断端吻合。临床应用 2 6例。结果 :获得随访 2 6例 ,随访时间 3～ 36个月 ,平均 2 1个月。2 5例健在 ,排尿可控率 1 0 0 % ,术后 1 2月2 0例平均尿量 585.6ml/次 ,残余尿 2 2 ml。 Qmax1 7.3ml/ s。膀胱测压 1 8例 ,平均半充盈、充盈和排尿压力为 1 2 cm H2 O、1 7.6cm H2 O、53cm H2 O。尿常规正常 ,尿培养 (- ) ;肾功能及血生化正常 ,无肾、输尿管积水。病理示新膀胱粘膜变薄 ,粘膜腺体减少 ,绒毛消失 ,部分区域固有膜腺体消失 ,呈鳞状化生结构。PAS染色阳性 ,HSP阳性、P53阴性。结论 :球形可控回肠贮尿袋代膀胱术具有容量大、压力低、可控性好 ,对机体干扰轻 ,并发症少 ,病人易接受等优点 ,是原位膀胱重建的好术式。

Objective:To investigate reconstruction the bladder with approximate nomal function.Methods:An isolated intestinal segment of 30cm distal ileum was formed as a globular reservior.The distal ureter was anti reflexly anastomoset to the reservoir.The lowest epartment of reservior was anastonoset to urethra.This method was used in 26 cases of bladder neoplasms after total cystectomy.Results:All cases were followed up for 3 36 months with a mean of 21 months.Good continence has been achieved during day time in all (100%) and at night in 90% 12 months after operation,and mean urine quantity of every times was 585.6 ml.The mean filling pressure of pouth was 17.6 cmH 2O and the pressure during urination was 53 cmH 2O.The uroflow rate was good with mean maxinal flow rate of 17.3 ml/s in 20 patients.There was evidenee of ureterel reflux and narrow.The renal function,serum electrolytes and urin test were normal.One patients died of cerebral haemorrhge.Conclusion:The globular continent orthotopic ileal reservoir is suitable for patients after total cystectomy.It provides a large capacity and a low intrareservoir pressure,with improving life quality of patients.