摘要
目的探讨膀胱癌根治术后T型回肠新膀胱术的手术方法及临床应用价值。方法对25例膀胱癌患者施行T型回肠新膀胱术:截取一段54 cm左右的回肠,利用远端的44 cm肠管做成储尿囊,而近端的10 cm肠管作为新膀胱的输入袢,并通过将输入袢远端的5 cm肠管包埋于构成储尿囊两肠管之间的浆膜隧道内而形成抗返流机制。结果25例手术经过顺利,术后3周拔除尿管后均能自控排尿,尿量为50～200 ml。术后3个月复查尿常规无异常,肾功能及电解质无异常。尿动力学检查,新膀胱最大容量为(327.3±62.7)ml,最大尿流率为(16.2±7.9)ml/s,充盈期膀胱内压力为0～8 cmH2O,排尿期膀胱内压力为8～16cmH2O,剩余尿为0～40 ml。静脉肾盂造影或B超检查,结果表明无肾积水、无输尿管扩张。膀胱造影未见输尿管返流。结论原位T型回肠新膀胱术具有良好的可操作性、较好的尿控及排尿能力,是一种良好的尿流改道术,值得临床推广应用。
Objective To explore the operation method and its clinical application value of T pouch ileal neobladder operation after the radical correction of carcinoma of bladder. Methods 25 patients with carcinoma of bladder were performed T pouch ileal neobladder operation. 54 cm terminal portion of the ileum was used to construct the T-pouch. The distal 44 cm ileum was used to form the reservoir, while the proximal 10 cm ileum was used to form the afferent antireflux mechanism by anchoring the distal 5 cm afferent ileal segment into the serosal lined ileal trough formed by the base of the 2 adjacent ileal segments. Results All the operations turned to be smooth during the surgery. 25 patients were able to void completely after pulling out the catheter 3 weeks postoperatively. The urine volume was found to be 50 to 200 ml. The patients came back to the hospital for routine examination 3 months after surgery. Their urinalysis and renal function were normal and there was no electrolyte disorder. The maximum cystometric capacity was （ 327.3 ± 62.7 ） ml and the maximum flow rate was （ 16.2 ±7.9）ml/s. The bladder pressure was 0 to 8 emil20 during filling phase while 8 to 16 emil20 during voiding phase, and the residual urine was from 0 to 40 ml. There were no hydronephrosis and dilation of ureters through the examination of excretory urography and B-ultrasound. Cystography showed no urinary reflux. Conclusion The orthotopic T pouch ileal neobladder operation which is a feasible and good urinary diversion with good voiding ability and continence is worth spreading and applying.
出处
《白求恩军医学院学报》
2009年第3期129-131,共3页
Journal of Bethune Military Medical College
关键词
膀胱肿瘤
尿流改道
新膀胱术
Bladder tumor
Urinary diversion
Neobladder
