可控膀胱增强缩窄回肠控制机能的临床研究

Enhanced continent mechanism of the tapered ileum in continent urinary reservoir

目的 设计一种控尿可靠 ,导尿容易和手术方法简单的可控膀胱输出道。 方法 对2 0例尿流改道的患者 ,采用缩窄的回肠作为输出道 ,并将部分输出道固定在回肠储尿囊与腹壁之间 ,输出道的内口与回肠储尿囊作端侧吻合 ,其外口与脐孔作端端防狭窄吻合的手术方法治疗。术后1 5～ 3个月和 6～ 17个月分别对输出道和储尿囊行尿动力学检查。 结果 1例术后 5 5d死于心脏疾病 ,其余 19例中 ,18例术后昼夜能控制尿。术后 1 5～ 3个月尿动力学显示 :储尿囊充盈时输出道最大闭合压为 46～ 12 4(92± 17)cmH2 O(1cmH2 O =0 0 98kPa) ,空虚时 34～ 84(6 7± 12 )cmH2 O ,两者间差异有非常显著性意义 (t=10 5 9,P <0 0 1) ;6～ 17个月 12例行尿动力学检查 ,储尿囊充盈时输出道最大闭合压为 77～ 15 4(10 1± 2 1)cmH2 O ,空虚时为 5 6～ 115 (74± 15 )cmH2 O ,两者差异有非常显著性意义 (t=8 5 4,P <0 0 1) ;储尿囊容量为 36 0～ 75 0 (4 5 5± 111)ml,充盈时内压为 16～ 35 (2 3± 6 )cmH2 O ,充盈过程中没有收缩波出现。 结论 储尿囊与腹壁的壁外支持可明显增强缩窄回肠的控尿能力 。

Objective To construct a reliable continent tube that is easy to catheterize and is surgically simple. Methods From October 1999 through March 2001, 20 patients underwent a procedure in which ileal segment was tapered as an efferent tube and the partial efferent tube was placed between the back surface of the rectus muscle and the wall of the ileal pouch. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice of the tapered ileum was anastomosed to the umbilicus. Urodynamic study of the efferent tubes and pouch was done 1 5 to 3 months and 6 to 17 months after operation. Results The stoma was easily catheterized with a 16 F catheter in all patients. One patient died of heart disease 55 days after the operation, while 18 of the remaining 19 were completely continent day and night. At 1.5 to 3 months, the urodynamic study of the efferent tubes showed the maximum close pressure with a full pouch of 46 124 cmH 2O(91 53±17 21),and when the pouch was empty it was 34 84 cmH 2O(66 68±11 60), The difference in the mean maximum closure pressure in full and empty pouches was statistically significant ( t =10 59, P <0 01). At 6 to 17 months, urodynamic study was performed in 12 patients, the maximum closure pressure in the efferent tube was 77 to 154 cmH 2O (100 92±20 88) when the pouch was filled with saline. When the pouch was empty, it was 56 to 115 cmH 2O (74 08±14 59). The difference in the mean maximum closure pressure in full and empty pouches was statistically significant ( t =8 54, P <0 01). Reservoir capacity was 360 to 750 ml (455±110 74). When it was filled to the maximum, the reservoir pressure was 16 to 35 cmH 2O (23 17±5 82). There was no contractive wave in filling in any patient. Conclusions This study indicates that the continent mechanism of the tapered ileum can be greatly enhanced by fixing it between the abdominal and pouch walls. This maneuver also provides easy catheterization and surgical simplicity.