回结肠代膀胱术18例临床分析

Orthotopic detenia cecal-ascending colon urinary reservoir: report of 18 cases

目的 简化手术方法 ,提高全膀胱切除术患者的生存质量。 方法 对 18例膀胱癌患者施行根治性膀胱切除术后 ,采用全部剔除网膜结肠带及前结肠带和多处切断结肠环状肌的方法 ,建成低压储尿袋 ,行回结肠膀胱术。 结果 随访 6～ 2 0个月 ,18例患者白天完全可控 ,夜间完全可控13例 ,溢尿 3例。膀胱容量为 410～ 5 2 0ml,最大充盈压为 39～ 6 0cmH2 O ,剩余尿 15～ 46ml,最大尿流率 12～ 2 8ml/s。无输尿管狭窄或返流。 结论 回结肠膀胱术操作简单 ,并发症少 ,储尿囊压力低 。

Objective To improve the technique of detenia cecal ascending colon continent urinary reservoir for farther improving the life quality of the patient. Methods Orthotopic detenia cecal ascending colon urinary reservoir was carried out by complete resection of all the tenia and multiple transverse incision of colonic circular muscular layer for 18 patients with bladder cancer underwent radical cystectomy. Results The patients have been followed up for 6 20 months. All were completely continent during the day and 13 patients got complete continence at the night. Only 3 patients had nocturnal incontinence. The capacity of the urine reservoir was 410 520 ml. The maximum intrareservoir pressure was 39 60 cmH 2O, while the post micturition residual volume was 15 46 ml and the maximum flow rate was 12 28 ml/per second. No evidence of ureter reflux and ureteral obstruction was observed and serum electrolytes were normal in all patients. Conclusions Orthotopic detenia cecal ascending colon urinary reservoir shows good clinical and functional results, and the simple technique, exerts low pressure in the reservoir and produces minimal complications.