改良式乙状结肠直肠储尿囊术的临床效果评价

Clinical analysis of improved sigmoid colon rectum allantoic storage technique

目的评价改良式乙状结肠直肠储尿囊术的临床效果。方法 1992年2月至2014年6月,对48例肌层浸润性膀胱癌患者行根治性膀胱全切,在原Mainz膀胱Ⅱ式手术基础上进行可控尿流术式,即改良式乙状结肠直肠储尿囊术。结果术后随访3个月到5年结果显示：B超检查34例患者有单侧肾盂轻度扩张2.5cm,排尿稳定可控,最大容量为450~600mL;19例患者血CO2cp提示偏酸,口服碳酸氢钠,肾功能均在正常范围,均可蹲位自行排尿,可控,尿粪均完全分开,大便成形,偶有夜间尿失禁。死亡5例,其中1例术后1周因绞窄性肠梗阻、感染性休克死亡,1例术后1年因为急性心肌梗塞死亡,2例3年后因肿瘤转移死亡,1例死因不详。肿瘤复发转移6例,其中肺转移2例,盆腔局部转移3例,尿道转移1例。48例患者中1例手术后20年仍健在。结论改良式乙状结肠直肠储尿囊术简单易行,在减少尿粪合流、逆行感染、代谢性酸中毒方面效果明显,并发症少,生活质量高,接近正常生理,有仿生学意义,是医患双方均易于接受的术式,且适应证相对较广,是一种较好的可控性尿流改道方法。

Objective To evaluate the therapeutic effects of modified sigmoid colon rectal storeage allantoic. Methods During Feb. 1992 to Jun. 2014, 48 cases of invasive bladder cancer patients underwent radical cystectomy, on the basis of orig- inal Mainz bladder surgery II type controlled urine flow operation, which modified the sigmoid colon rectum allantoic storage technique. Results During the follow-up of 3 months to 5 years, 34 patients had 2.5 cm expansion of unilateral renal pelvis, the urination was stable and controllable, and the maximum capacity was 450~600 mL. 19 patients＇ blood COzcp suggested partial acid. After oral sodium bicarbonate, the renal function recovered, and the urination was controllable. Besides, urine and stool could be completely separated, with occasional incontinence at night. 5 cases died, of which 1 case died of strangula- tion obstruction and septic shock 1 week after operation, 1 case died of acute myocardial infarction 1 year after operation, 2 cases died of tumor metastasis 3 years after operation, and 1 case died of unknown cause. Tumor recurrence and metastasis oc- curred in 6 cases, 2 of which had pulmonary metastasis, 3 had pelvic cavity metastasis, 1 had urethra metastasis. Of all cases, I patient was still alive 20 years after the operation. Oonclusions Improved sigmoid colon rectum allantoic storage technique is simple and effective in reducing urine stool confluence, retrograde infection, and metabolic acidosis. It produces fewer com- plications and maintains high quality of life. It is easily accepted by both doctors and patients, and has wide indications.