改良Sigma直肠膀胱术中输尿管单腔、并腔肠吻合的疗效分析  

An analysis of the curative effect of 1 and 2 ureters anastomosis in modified sigma operation

作　　者：虞立平[1] 史文华[1] 段建春[1] 戴国芳[1] 徐涌波[1] 陈伟军[1] 周林秋[1] 

机构地区：[1]江苏大学附属金坛医院泌尿外科,213200

出　　处：《中华泌尿外科杂志》2011年第5期318-320,共3页Chinese Journal of Urology

摘　　要：目的评价改良Sigma直肠膀胱术中输尿管单并腔肠吻合的疗效。方法对14例膀胱多发移行细胞癌、1例膀胱腺癌根治性膀胱全切术后患者行改良Sigma直肠膀胱术。折叠25cm直肠乙状结肠缝合成U形储尿囊，其中输尿管分别单腔与储尿囊吻合5例、双输尿管末端1．5～2．0cm并腔缝合后与储尿囊吻合10例。结果15例患者控尿良好，无明显水电解质酸碱紊乱，术后15-22d痊愈出院。13例随访8～24个月，其中输尿管单腔肠吻合4例出现吻合口狭窄、轻～重度肾积水，并腔肠吻合9例未出现肾积水。结论改良Sigma直肠膀胱术创伤小、并发症少，患者可通过肛门括约肌自控排尿，无需配带尿袋或间断导尿，符合生理要求，提高了患者的生活质量；输尿管并腔后吻合口径大，不易发生狭窄等严重并发症。Objective To make a comparison of curative effect of 1 and 2 ureters anastomosis in modified sigma operation. Methods Modified sigma operation was used after radical cystectomy in 14 cases of bladder transitional cell carcinoma and 1 case of adenoearcinoma of the bladder. We used a folded suture of 25 cm from the sigmoid colon to make the U-shaped urinary reservoirs to anastomose with the ureters in study group. Among study group, Ⅰ ureter was anastomosed with urinary reservoir in 5 cases. In the other 10 cases, 1.5--2 cm of the terminal parts of 2 ureters were sutured tI am not sure what the authors mean by ＂big diamogether and then anastomosed with the urinary reservoir. Results 15 cases obtained good voiding control and no obvious water-electrolyte disturbance occurred. All the patients were cured and discharged within 15 to 22 days. Thirteen cases were followed-up in 8 to 24 month time period. Anastomotic stenosis and moderate-severe hydronephrosis occurred in 4 cases with 1 ureter anastomosis. No hydronephrosis occurred in the 9 cases with 2 ureters anastomosis. Conclusions Modified sigma operation has the advantages of less injury and fewer complications. The patients can obtain self-control urination by anal sphincter without urine bags or intermittent catheterization, so the life quality of the patients is improved. Modified sigma operation with 2 ureters anastomosis has big diameter and there was a lower incidence of serious complications such as anastomotic stenosis.

关 键 词：膀胱肿瘤 尿流改道 吻合口狭窄 

分 类 号：R737.14[医药卫生—肿瘤]