改良Studer回肠膀胱成形术15例报告

目的 :探讨理想的膀胱代替手术。方法 :回顾性分析 10年来所施行的改良 Studer回肠膀胱成形术 15例的手术情况 ,对 Studer作了三点改良 :1将近端尿道输入瓣由 2 0 cm改为 15 cm;2尿道内放入 F2 2 导尿管 ;3远端 2 / 3肠瓣完全去管道。结果 :15例平均随访 15个月 ,1例再手术 ,1例出现肾积水 ,白天和夜间尿液可控率分别为 95 %和 93%。结论 :改良 Studer回肠膀胱成形术并发症少 ,成功率高 ,符合容量适当、低压、可控、可保护上尿路的理想术式要求。

贮尿囊与腹壁的壁外支持增强缩窄回肠控制机制的临床研究

目的 建立一种控尿可靠、导尿容易和手术方法简单的输出管。 方法 选用缩窄后的回肠作为输出管 ,输出管的内口与贮尿囊作端侧吻合 ,其外口与脐孔作端端吻合 ,并将部分输出管固定在贮尿囊与腹壁之间的手术方法治疗 10例膀胱癌患者。术后对输出管和贮尿囊作尿动力学和X线检查。 结果 1例术后 5 5d死于心脏疾病 ,余 9例中 8例白天和晚上均能控制排尿 ,术后尿动力学检查示贮尿囊充盈时输出管最大闭合压明显高于贮尿囊空虚时输出管最大闭合压 ,两者间比较差别有显著性意义 (t=- 7.14,P =0 .0 0 0 0 98)。 结论 采用回肠贮尿囊与腹壁的壁外支持可明显增强缩窄回肠的控制能力。

Hand-assisted-drawing-needle running suture with a curved needle： an effective technique to create a W-ileal neobladder

Background An important milestone in the area of urinary diversion was the advent of a series of orthotopic bladder substitution （OBS）. However, reconstruction of OBS by the traditional hand suture method （THSM） is a time-consuming process. Stapling techniques are considered to be inferior to hand-sewn methods. We report our experience and functional results in patients with W-ileal neobladder by a hand-assisted-drawing-needle running suture （HADNRS）. Methods Between April 1993 and December 2011, 347 patients （338 men and 9 women） aged 28-77 years （median age： 59 years） underwent radical cystectomy, followed by the creation of a modified W-ileal neobladder by HADNRS with a curved needle. A total of 347 （20 patients in 2003） were evaluated by urodynamic tests. Results The operative time ranged from 110 to 310 minutes （mean 148 minutes）, and the mean time of reconstruction by HADNRS, excluding ureterointestinal and ileouretral anastomosis, was （20.2±4.3） minutes. Histopathological analysis of removed specimens showed that 317 patients had transitional cell bladder carcinoma. Of these 317 patients, 19 also had squamous carcinoma and 13 had adenocarcinoma. Glandularis and prostate cancer occurred in 16 and 14 patients, respectively. Three patients （0.8%） had neobladder abdominal fistula. No other early complications or injury to the surgeon＇s hands occurred due to HADNRS. Of the 20 cases with urodynamic examinations in 2003, two suffered from daytime incontinence and six had nocturnal incontinence. The maximum capacity of the neobladder was （492.9±177.8） ml, and the maximum pressure within the reservoir at the end of filling was （32.1±8.6） cmH2O.Conclusion Reconstruction of W-ileal neobladder by HADNRS is effective and economical.

可控膀胱增强缩窄回肠控制机制的尿动力学研究(英文)

目的 探讨贮尿囊与腹壁的壁外支持对增强缩窄回肠控尿能力的作用。方法 2 4例尿流改道的病人采用缩窄的回肠作为输出管 ,并将部分输出管固定在回肠贮尿囊与腹壁之间 ,输出管的内口与回肠贮尿囊作端侧吻合 ,其外口与脐孔作端端防狭窄吻合的手术方法治疗。术后 1 5 - 3个月和 6 -2 4个月分别对输出管和贮尿囊作尿动力学检查。结果 1例术后 5 5天死于心脏疾病 ,余 2 3例中 2 2例术后昼夜能控制尿。术后 1 5 - 3个月尿动力学检查示贮尿囊充盈时输出管最大闭合压为 4 6± 12 4cmH2 O(91 2 6± 15 71cmH2 O) ,空虚时 34- 84cmH2 O(6 7± 10 6 0cmH2 O) ,两者间差异有显著意义 (t=- 11 78,P <0 0 0 0 1) ;6 - 2 4个月 18例行尿动力学检查 ,贮尿囊充盈时输出管最大闭合压为 80 - 194cmH2 O (98 89± 2 6 34cmH2 O) ,空虚时为 6 4- 12 8cmH2 O (74 78± 14 5 4cmH2 O) ,两者差异有显著性意义 (t=- 7 5 8,P <0 0 0 0 1)。贮尿囊容量为 4 2 0 - 75 0ml (481 6 7± 78 83cmH2 O) ;贮尿囊注入 5 0ml生理盐水时内压为 6 - 9cmH2 O (7 17± 1 17cmH2 O) ;贮尿囊充盈时内压为 16 - 35cmH2 O (2 4 12± 5 6 1cmH2 O) ,充盈过程中没有收缩波出现。