膀胱全切术后体外可控性回肠代膀胱术

Urinary diversion by ileal reservoir with self controllable urination after cystectomy

目的 探讨膀胱全切术后尿流改道新方法即体外可控性回肠代膀胱术的可行性及疗效。方法 取一段回肠 ,将中间部分折叠成N形并缝制成贮尿囊 ;远端回肠从腹壁造瘘口穿出体外 ,于此处取腹壁皮瓣包绕外露肠管缝制成皮管 ,构建输出道 ;将尿液控制器置于皮管外 ,利用气囊控制排尿。结果 10只杂交狗顺利度过手术期 ,术后 3月时贮尿囊最大容量为 (15 0± 4 0 )ml,最大充盈压为 (2 4 .4± 5 .3)cmH2 O。临床应用 5例 ,随访 (3～ 14 )月 ,术后 3月时贮尿囊最大容量达 (2 90± 80 )ml,最大充盈压为 (36 .3± 8.2 )cmH2 O ,最大尿流率为 (2 0 .3± 4 .7)ml s,无残余尿。X线影像学检查 ,肾脏显影良好 ,输尿管通畅。尿液控制器的气囊充气后 ,无尿液流出 ;气囊消气后 ,尿液呈粗线条流出。结论 该尿流改道术式具有体外自主控制排尿的特点 ,不必佩戴集尿袋或自行导尿 ,且手术操作比较简单、并发症少、安全可靠。

Objective To investigate the feasibility and effect of the urinary diversion after cystectomy by ileal reservoir with self controllable urination . Methods A segment of ileum was taken, from which, the middle portion was made into N shaped reservoir. The distal ileum was pulled out off the stoma where the skin flaps were taken and encircled the different ileum to constitute the urinary outflow. A urinary controller was applied to control the urination. Results Ten dogs and five patients underwent this new operation and the patients were followed up for 3 to 14 months. Three months after the operation, the animal reservoir reached a maximum capacity of (150±40)ml, the mean maximum capacity of human reservoir was (290±80)ml, a full filling pressure of (36.3±8.2) cm H 2O, a maximum urinary flow rate of (20.3±4.7)ml/s and no residual urine. X ray examination showed good excretory function of the kidney without hydronephrosis. All patients can control urination through the urinary controller. Conclusion The new procedure has advantages of self control of urination , simple surgical performance , few complications and good reliability.