输出管悬吊可控膀胱术的临床研究

A clinical study of efferent tube suspension for continence diversion

目的 设计一种控尿可靠、导尿容易、并发症少且操作简单的可控性膀胱输出道的手术方法。方法 2 0例需行可控性尿流改道的患者采用输出道悬吊的手术方法进行治疗。患者中 14例为膀胱恶性肿瘤 ,2例为已行回肠膀胱术 (bricker术 )者 ,3例为重症神经源性膀胱 ,1例为膀胱阴道瘘。结果 术后随访 3～ 2 4个月 ,平均 14 .4个月 ,所有患者的腹壁造口均可容易地插入 16F导管。术后仅 1例控制尿不完全 ,其余患者均控制尿完全。 16例术后 3～ 12个月行尿动力学检查 ,膀胱充盈时输出管最大内压为 64～ 13 4cmH2 O( 1cmH2 O =0 .0 98kPa) ,平均为 86cmH2 O。腹壁造口逆行造影示输出管被固定在腹壁下 ,无狭窄。结论 输出管悬吊能明显增强缩窄回肠的控制机制 。

Objective To construct a reliable continent tube, which is easy to catheterize and surgically simple. Methods A total of 20 patients underwent a procedure of a continence diversion and efferent tube suspension. Of these patients, there were malignant bladder tumor in 14, severe neuropathic bladder in 3, ileal conduit (bricker) in 2 and vesicovaginal fistula in 1. Results The patients were followed up for 3～24 months (mean 14.4) and were completely continent except one 1. The stoma was easily catheterized with a 16 F catheter in all cases. Urodynamic study of the efferent tubes was carried out in 16 patients and showed the maximum pressure ranged from 64 to 134 cm H 2O (mean 86 cm H 2O). Retrograde radiography of the efferent tubes demonstrated perfect canalization without stenosis. Conclusion This study suggests that the continent mechanism of tapered ileum can be greatly enhanced by a simply suspension technique.