盲结肠膀胱术加强输出道可控机制的临床研究

Cecal-ascending colon continent urinary reservoir

目的 改进盲结肠膀胱术输出道手术方法 ,建立一种控尿可靠、插管方便、并发症少的可控输出道。 方法 对 4 7例膀胱癌患者行膀胱癌根治切除 ,37例采用去结肠带建立盲结肠贮尿囊 ,10例非管状化建立盲结肠贮尿囊 (改良Indianapouch) ,截取末端回肠 12～ 14cm ,剖开肠管重叠绕圈缝合成双层肠壁结构 ,回盲肠交界处浆肌层缝合 ,构筑回盲部小乳头状回肠套叠结构 ,建成长 12cm的输出道。盲肠端与盆腔腹壁缝合 ,远端与脐孔吻合 ,全长固定潜行于腹壁下贮尿囊和腹直肌之间。 结果 全部患者插管顺利 ,白天完全可控 4 5例 ,夜间完全可控 4 4例 ,术后 6个月输出道闭合压 4 0 .5～ 12 5 .6cmH2 O ,充盈状态输出道最大闭合压明显高于空虚状态 (P <0 .0 5 )。 结论 改进的缩窄末端回肠输出道是一种较理想的可控输出道。

Objective To modify and improve the technique of continent outlet and to find an optional method of simpler construction and easier catheterization. Methods 47 patients underwent continent cecal-ascending colon urinary reservoir were followed up,among whom 37 were detenial and 10 were detubularized. All reservoirs used incisive terminal ileum being overlapped and sutured again as efferent tube. The limb was fixed between the back surface of the rectus and the pouch wall. The internal orifice of the overlapped ileum was ileocecal valve reinforced with few sutures.Its external orifice was anastomosed to the umbilicus.Urodynamic studies of the pouch and efferent limb were carried out more than 6 months postoperatively. Results All the tubes were easily catheterized with 16 F catheter.45/47 patients were completely continent during the day and 44/47 patients completely continent at night. Urodynamic study of the efferent tubes showed that the maximum close pressure with the pouch full was significantly higher than with the pouch empty( P <0.05). Conclusions The created ileal tubes are wide and straight enough to be catheterized easily and are reliable and continent.