改良MainzⅡ术式在膀胱全切后尿流改道中的应用

The Clinical Application of Modified Mainz Pouch ⅡSurgical Urinary Diversion after Cystectomy

膀胱肿瘤等需要行膀胱全切的疾病日趋增多,膀胱全切后可控性尿流改道的应用日益广泛,尿流改道的手术方式多种多样。到目前为止,膀胱全切术后的尿流改道尚无标准的术式,理想的替代膀胱应接近正常的生理功能,维持一定的排尿时间间隔,尿控良好,并发症少。乙状结肠直肠膀胱术（改良Mainz pouchⅡ）,将双侧输尿管再植于去管状化的乙状结肠直肠储尿囊,术后利用肛门括约肌控制排尿。该手术时间短,出血少,操作方便,对肠管扰动小,术后尿控、排空满意,肾盂肾炎、代谢性酸中毒等并发症少。所有患者在2-3个月以后能将大小便分开,患者不需要佩戴集尿袋或间断性导尿,生活可以自理,生活质量明显得到改善;因此,是一种比较好的可控性尿流改道方法。本文就近年来的研究进行分析总结,希望经过进一步的改良,改良MainzⅡ术式成为尿流改道中非常重要的方式之一,在特定的情况下会替代其他类型的尿流改道。

The bladder cancer and other need cystectomy are growing. Continent Urinary Diversion is widely used after radical cystectomy, urinary diversion operation method is varied. So far, there is no standard procedure of urinary diversion. The ideal alternative bladder should be close to the normal physiological function, to maintain a certain time interval urination, better urinary control and less complications. Detubularized Sigmoid Colon rectum bladder（modified Mainz pouch Ⅱ）, making the bilateral ureteral reimplantation in the detubularized sigmoid rectum pouch, control urination by anal sphincter. This operation is shorter of operative time, less bleeding,easy to operate, for small bowel disturbances, postoperative urinary control, emptying satisfaction, lower rate of retrograde infection and metabolic acidosis. All patients were able to distinguish between stool and urine about two months after operation, do not need to wear urine collection bags or intermittent catheterization, can take care of themselves, the quality of life improved significantly. Therefore, it is a kind of good controllability urinary diversion method. This review will analyze and summarize the results of recent studies, hoping that after further improvement, modified Mainz pouch Ⅱ will become one of important controllability urinary diversion methods, and can replace other types of urinary diversion under certain circumstances.