摘要
目的:综合评价膀胱全切改良MainzⅡ尿液转流术的临床效果。方法:对31例膀胱根治性切除患者行改良MainzⅡ尿液转流术,即乙状结肠及直肠"N"形折叠缝合去管囊化形成低压肠袋,分别于术后3个月、6个月、1年、2年、3年、4年、5年监测肾功能、血电解质和输尿管、肾盂反流及上尿路并发症,同时作肿瘤患者生活质量评价(QOL)。结果:全组手术顺利,手术时间180～240 min,平均210 min,失血量200～1400 ml,平均370ml。随访6～60个月,1例术后10天出现肠漏(尿粪漏),经留置盆腔引流管(经尿道置入),加强肛管引流而愈;3例膀胱肿瘤复发,术后8～24个月因肿瘤复发转移死亡;余28例恢复良好。术后综合评估结果:①上尿路并发症(>3个月):3例上尿路感染7次,经抗感染治愈;3例一侧、1例两侧肾盂轻度扩张,经观察未加重,1例一侧肾盂中度扩张,正在观察中;输尿管、肾盂反流:4例贮尿囊造影无输尿管、肾盂反流。②生化检查:死亡的3例患者在晚期多项生化指标有不同程度异常;上尿路感染的3例在急性期尿素氮、血肌酐、尿酸有轻中度升高,其余25例肾功能、血钾、血钠、血氯、血浆二氧化碳结合力均正常,无高氯血症、代谢性酸中毒。③控尿率:3个月后昼夜静息及日常活动时的尿液均可控,控尿率为100%。④夜尿次数:3个月后,晚11时到次日晨7时夜尿1～3次,尿粪可分开排泄,尿量320～550 ml,平均410 ml。⑤QOL评分:本组38～52分,平均45分,生活质量较好。结论:改良MainzⅡ尿液转流术较易操作,并发症少,生活质量较高,接近正常生理,有仿生学意义,是医患双方均易于接受的术式。
Objective：To evaluate the clinic effect of radical cystectomy with modified Mainz-Ⅱ pouch rectum conduit. Methods： From January 2005 to January 2010, a total of 31 patients underwent modified ureterosigmoidostomy（mainz pouch Ⅱ ）. A length of 30-36 cm superior rectum and inferior sigmoid was folded into ＂N＂ shape and opened antimesenterieally. The lateral limbs are joined together with two-layer interrupted suture to create posterior reservoir wall. The ureter implanted using the submucosal tunneling technique. Anterior lateral limbs are su- tured together with silk described above. We detected the serum creatinine, blood urea nitrogen sodium, potassium, chloride ions in every patienfs plasma at post-operation three month, six month and from first year tO five year. At the same time, we performed intravenous pylonephrography to search superior ureteral system injury, investigated the patient＇s quality of life by questionnaire. Results.. We carried out radical cystectomy and ureterosigmoidostomy successfully in every case. The mean operation duration was 210rain （180-240 min）, the mean bleeding 370 milliliter （200-140 ml）. The range follow-up was from 6 to 60 months. There were no peri-operation death. 1 patient with urine leakage at postoperation 10 day, who was healed by inserting catheter into pelvic transurethrally. 3 patients were death for tumor metastasis at 8-24 month after operation, the rest patients were followed up until the present. There were 3 cases suffered from pyelonephritis for seven times, all patients were managed conservative- ly, and none needed surgical intervention. Three patients with unilateral ureterohydronephrosis, one patient with bilateral ureterohydronephrosis, we detected no worse in these patients. One patient with unilateral medium hy- dronephrosis is following up. We didfft found new bladder-ureter reflux in four reservoir radiography. In the plas- ma biochemistry detection, all except for three dead patients and three patients with acute upper urinary t
出处
《临床泌尿外科杂志》
北大核心
2011年第9期681-683,共3页
Journal of Clinical Urology
关键词
膀胱肿瘤
膀胱全切术
尿液转流术
综合疗效评估
bladder neoplasm
radical cysteetomy
urinary diversion
comprehensive effect
