用自制引导探子在正位回肠膀胱术中引导新膀胱尿道吻合48例报道  

Application of handmade guiding probe in guiding neo-bladder-urethral anastomosis in radical cystectomy ileal orthotopic bladder replacement(Report of 48 cases)

作　　者：余闫宏[1] 肖民辉[1] 张科[1] 黄杰[1] 杨小华[1] 齐书武[1] 

机构地区：[1]云南省第一人民医院泌尿外科

出　　处：《重庆医学》2010年第16期2114-2116,共3页Chongqing medicine

摘　　要：目的探讨在膀胱全切正位回肠膀胱术中应用自制的带顶端引导孔金属尿道探子引导新膀胱尿道吻合的价值。方法 2001年1月至2009年1月对未保留前列腺尖被膜的膀胱全切正位回肠膀胱术患者48例应用自制带顶端引导孔金属尿道探子,于12、2、4、6、8、10点引导5/8园2-0Vicryl线缝针,行新膀胱尿道的间断黏膜外翻吻合。结果吻合均顺利完成。吻合操作时间为5～10min。3～4周拔出尿管后,排尿通畅。获访42例,术后3、12个月内恢复尿控能力分别为9、17例,1年尿控功能恢复率为61.9%。保留神经血管束获访17例,术后3、12个月内勃起功能恢复分别为2、7例,5例勃起功能减弱,3例不能勃起,1年勃起功能恢复率为52.9%。结论应用自制带顶端引导孔金属尿道探子引导新膀胱尿道吻合,操作便捷,缝合精确,有效保障吻合口通畅,减少吻合口狭窄和漏尿,有利于盆底尿控结构及神经血管束的保护。Objective To evaluate the application of handmade metal urethral probe with tip guiding hole in guiding neo-bladderurethral anastomosis in radical cystectomy ileal orthotopic bladder replacement.Methods 48 cases had been undergone radical cystectomy ileal orthotopic bladder replacement without reservation of prostate apex capsule during January 2001 to January 2009,in which all cases underwent neo-bladder-urethral mucosa extrovert intermittent anastomosis at 12,2,4,6,8,10 points by guiding 5/8 round needle 2-0 Vicryl wire using handmade metal urethral probe with tip guiding hole.Results The anastomosis for all cases were successful,the operatng time for anastomosis was 5-10min.Micturition was fluent after urethral catheters were removed in 3-4 weeks,in 42 cases followed-up,functional recovery of urinary continence occurred within 3 months after surgery in 9 cases and 12 months in 17 cases.The ratio of functional recovery of urinary continence within 1 year was 61.9%,17 cases with reservation of neurovascular bundles were followed up,in which the recovery of erectile function occurred within 3 months after surgery in 2cases and 12 months in 7 cases,erectile function was impaired in 5 cases,erectile dysfunction occurred in 3cases,and the ratio for recovery of erectile function within 1 year was 52.9%.Conclusion Neo-bladder-urethral anastomosis through application of handmade metal urethral probe with tip guiding hole is convenient and accurate and can effectively ensure fluent anastomosis area,reduce anastomosis area stricture and urine leaking,and is beneficial for protection of pelvic bottom urinary continence structure and neurovascular bundles.

关 键 词：膀胱肿瘤 正位回肠膀胱术 膀胱尿道吻合 手术器械改良 

分 类 号：R737.14[医药卫生—肿瘤] R730.56[医药卫生—临床医学]