OBJECTIVE: To investigate the effect of extramural support from the pouch and abdominal wall to enhance the continent mechanism of tapered ileum. METHODS: A total of 24 patients underwent a procedure in which an ileal...OBJECTIVE: To investigate the effect of extramural support from the pouch and abdominal wall to enhance the continent mechanism of tapered ileum. METHODS: A total of 24 patients underwent a procedure in which an ileal segment was tapered into an efferent tube, of which a part was placed between the back surface of the rectus muscle and the ileal pouch wall. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice was anastomosed to the umbilicus. A urodynamic study of the efferent tubes and pouch was done 1.5 to 3 months and 6 to 24 months postoperatively. RESULTS: One patient died of heart disease 55 days postoperatively, while 22 of the remaining 23 were completely continent day and night. At 1.5 to 3 months, the urodynamic study of the efferent tubes demonstrated that the maximum closure pressure with a full pouch was 46 - 124 cmH(2)O (91.26 +/- 15.71 cmH(2)O) and with an empty pouch was 34 - 84 cmH(2)O (67 +/- 10.60 cmH(2)O). The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t = -11.78 and P = 0.00001). At 6 to 24 months, a second urodynamic study was performed on 18 cases, demonstrating a reservoir capacity of 420 to 750 ml (481.67 +/- 78.83 ml). Reservoir pressure was 6 to 9 cmH(2)O (7.17 +/- 1.17 cmH(2)O) when the pouch was filled to 50 ml, and 16 to 35 cmH(2)O (24.12 +/- 5.61 cmH(2)O) when it was filled to maximum capacity. There was no contractive wave during the filling in any patient. Maximum closure pressure in the efferent tube was 80 to 194 cm H(2)O (98.89 +/- 26.34 cmH(2)O) when the pouch was filled with saline, and 64 to 128 cmH(2)O (74.78 +/- 14.54 cmH(2)O) when the pouch was empty. The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t = -7.58 and P = 0.00003). CONCLUSIONS: This study indicates that the continent mechanism of tapered ileum may be greatly enhanced by extramural support from the abdominal and pouch walls.展开更多
目的:使用国产图迈机器人行腹腔镜根治性前列腺切除手术,观察其安全性及使用效果。方法:收集2023年1月至2023年5月前列腺癌患者40例,患者均行机器人辅助腹腔镜根治性前列腺切除术,采取保留膀胱颈和最大长度功能性尿道的手术方法。按使...目的:使用国产图迈机器人行腹腔镜根治性前列腺切除手术,观察其安全性及使用效果。方法:收集2023年1月至2023年5月前列腺癌患者40例,患者均行机器人辅助腹腔镜根治性前列腺切除术,采取保留膀胱颈和最大长度功能性尿道的手术方法。按使用机器人系统不同,分为观察组(图迈机器人组)和对照组(达芬奇机器人组),观察机械臂安装时间、腔内手术时间、尿道吻合时间、术中出血量、术后尿控等指标。结果:所有患者均顺利完成手术,观察组和对照组机械臂中位安装时间分别为6 min vs 5 min(P>0.05),腔内手术中位时间分别为146 min vs 130 min(P<0.05),尿道吻合中位时间分别为19 min vs 16 min(P<0.05),术中中位出血量分别为200 ml vs 150 ml(P>0.05)。术后即刻、1个月、3个月、6个月尿控恢复率分别为9/15(60.0%)vs 16/25(64.0%)、12/15(80.0%)vs 19/25(76.0%)、14/15(93.3%)vs 23/25(92.0%),15/15(100%)vs 24/25(96%),两组比较无显著差异(P>0.05)。结论:国产图迈机器人系统行腹腔镜根治性前列腺切除手术安全可靠,术后尿控效果满意。展开更多
Background Continent cutaneous diversion （CCD） has been widely used in almost any lower urinary reconstruction. We have been continually trying to modify this procedure because of the high complications rate, especi...Background Continent cutaneous diversion （CCD） has been widely used in almost any lower urinary reconstruction. We have been continually trying to modify this procedure because of the high complications rate, especially as they relate to the efferent tube. In this study, we reported a modified procedure with a tapered ileum wrapped by the rectus abdominalis flap （RAMF） and assessed the feasibility of this new technique to achieve urinary continence. Methods A procedure in which two ileal segments were tapered and connected to a U-shaped reservoir was performed in ten dogs. A RAMF with its blood supply was wrapped around one of the tapered ileum. In control groups, the tapered ileum was brought to the abdominal skin. Urodynamic studies were conducted In the 1st, 3rd and 6th months post-operatively. The data of maximum inner pressure （MIP） and functional pressure length （FPL） in every group at each phase were recorded. Retrograde radiograms of the efferent limbs were performed before sacrifice. Results MIP in the study group was significantly higher than that in the control group at each phase （P 〈0.05）. However no significant differences in MIP or FPL were found in the study group between an empty and full reservoir. In the control group, MIP increased （P 〈0.05） and FPL decreased significantly （P 〈0.05） compared with an empty and full reservoir. Retrograde radiograms confirmed that efferent limbs were positioned straigh beneath the abdominal wall. Histological examination of the study group demonstrated a layer of striated muscle around the outside surface of the ileum. Conclusion The continent mechanism of tapered ileum can be enhanced by extra support from wrapped RAMF.展开更多
Objective To evaluate and compare 3 kinds of cecocloln urinary reservoir. Methods Perm pouch, indiana pouch or detenial cecocolon reservoir has been performed for 37 patients. The outcome was evaluated by urodynamic a...Objective To evaluate and compare 3 kinds of cecocloln urinary reservoir. Methods Perm pouch, indiana pouch or detenial cecocolon reservoir has been performed for 37 patients. The outcome was evaluated by urodynamic and clinically. Results Good continence has been achieved in all patients with an appendiceal continence mechanism. The capacity and intrareservoir pressure of detenial cecocolon was significantly different from penn or indiana pouch 3 months postoperatively (P【0.01) whereas the difference became in no significant 12 months postoperativelly (P】0. 05). The intrareservoir pressure on contraction was lower with penn pouch. Conclusion The penn or modified indiana pouch is better and more ideal as a urinary reservoir whereas the detenial cecocolon pouch is technically simpler. 6 refs,1 tab.展开更多
基金ThisstudywassupportedbytheStateEducationScienceFoundationofChina (No 2 0 0 0 3 67)
文摘OBJECTIVE: To investigate the effect of extramural support from the pouch and abdominal wall to enhance the continent mechanism of tapered ileum. METHODS: A total of 24 patients underwent a procedure in which an ileal segment was tapered into an efferent tube, of which a part was placed between the back surface of the rectus muscle and the ileal pouch wall. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice was anastomosed to the umbilicus. A urodynamic study of the efferent tubes and pouch was done 1.5 to 3 months and 6 to 24 months postoperatively. RESULTS: One patient died of heart disease 55 days postoperatively, while 22 of the remaining 23 were completely continent day and night. At 1.5 to 3 months, the urodynamic study of the efferent tubes demonstrated that the maximum closure pressure with a full pouch was 46 - 124 cmH(2)O (91.26 +/- 15.71 cmH(2)O) and with an empty pouch was 34 - 84 cmH(2)O (67 +/- 10.60 cmH(2)O). The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t = -11.78 and P = 0.00001). At 6 to 24 months, a second urodynamic study was performed on 18 cases, demonstrating a reservoir capacity of 420 to 750 ml (481.67 +/- 78.83 ml). Reservoir pressure was 6 to 9 cmH(2)O (7.17 +/- 1.17 cmH(2)O) when the pouch was filled to 50 ml, and 16 to 35 cmH(2)O (24.12 +/- 5.61 cmH(2)O) when it was filled to maximum capacity. There was no contractive wave during the filling in any patient. Maximum closure pressure in the efferent tube was 80 to 194 cm H(2)O (98.89 +/- 26.34 cmH(2)O) when the pouch was filled with saline, and 64 to 128 cmH(2)O (74.78 +/- 14.54 cmH(2)O) when the pouch was empty. The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t = -7.58 and P = 0.00003). CONCLUSIONS: This study indicates that the continent mechanism of tapered ileum may be greatly enhanced by extramural support from the abdominal and pouch walls.
文摘目的:使用国产图迈机器人行腹腔镜根治性前列腺切除手术,观察其安全性及使用效果。方法:收集2023年1月至2023年5月前列腺癌患者40例,患者均行机器人辅助腹腔镜根治性前列腺切除术,采取保留膀胱颈和最大长度功能性尿道的手术方法。按使用机器人系统不同,分为观察组(图迈机器人组)和对照组(达芬奇机器人组),观察机械臂安装时间、腔内手术时间、尿道吻合时间、术中出血量、术后尿控等指标。结果:所有患者均顺利完成手术,观察组和对照组机械臂中位安装时间分别为6 min vs 5 min(P>0.05),腔内手术中位时间分别为146 min vs 130 min(P<0.05),尿道吻合中位时间分别为19 min vs 16 min(P<0.05),术中中位出血量分别为200 ml vs 150 ml(P>0.05)。术后即刻、1个月、3个月、6个月尿控恢复率分别为9/15(60.0%)vs 16/25(64.0%)、12/15(80.0%)vs 19/25(76.0%)、14/15(93.3%)vs 23/25(92.0%),15/15(100%)vs 24/25(96%),两组比较无显著差异(P>0.05)。结论:国产图迈机器人系统行腹腔镜根治性前列腺切除手术安全可靠,术后尿控效果满意。
文摘Background Continent cutaneous diversion （CCD） has been widely used in almost any lower urinary reconstruction. We have been continually trying to modify this procedure because of the high complications rate, especially as they relate to the efferent tube. In this study, we reported a modified procedure with a tapered ileum wrapped by the rectus abdominalis flap （RAMF） and assessed the feasibility of this new technique to achieve urinary continence. Methods A procedure in which two ileal segments were tapered and connected to a U-shaped reservoir was performed in ten dogs. A RAMF with its blood supply was wrapped around one of the tapered ileum. In control groups, the tapered ileum was brought to the abdominal skin. Urodynamic studies were conducted In the 1st, 3rd and 6th months post-operatively. The data of maximum inner pressure （MIP） and functional pressure length （FPL） in every group at each phase were recorded. Retrograde radiograms of the efferent limbs were performed before sacrifice. Results MIP in the study group was significantly higher than that in the control group at each phase （P 〈0.05）. However no significant differences in MIP or FPL were found in the study group between an empty and full reservoir. In the control group, MIP increased （P 〈0.05） and FPL decreased significantly （P 〈0.05） compared with an empty and full reservoir. Retrograde radiograms confirmed that efferent limbs were positioned straigh beneath the abdominal wall. Histological examination of the study group demonstrated a layer of striated muscle around the outside surface of the ileum. Conclusion The continent mechanism of tapered ileum can be enhanced by extra support from wrapped RAMF.
文摘Objective To evaluate and compare 3 kinds of cecocloln urinary reservoir. Methods Perm pouch, indiana pouch or detenial cecocolon reservoir has been performed for 37 patients. The outcome was evaluated by urodynamic and clinically. Results Good continence has been achieved in all patients with an appendiceal continence mechanism. The capacity and intrareservoir pressure of detenial cecocolon was significantly different from penn or indiana pouch 3 months postoperatively (P【0.01) whereas the difference became in no significant 12 months postoperativelly (P】0. 05). The intrareservoir pressure on contraction was lower with penn pouch. Conclusion The penn or modified indiana pouch is better and more ideal as a urinary reservoir whereas the detenial cecocolon pouch is technically simpler. 6 refs,1 tab.
