Sigma直肠膀胱术45例临床效果分析  

45 Cases of sigma rectum ouch for urinary division

作　　者：孙斌[1] 李贤初[1] 严景民[1] 李建业[1] 郭和清[1] 洪泉[1] 汪泽厚[1] 周高标[1] 潘广新[1] 

机构地区：[1]空军总医院泌尿外科,北京100142

出　　处：《空军医学杂志》2013年第1期50-53,共4页Medical Journal of Air Force

摘　　要：目的总结Sigma直肠膀胱术尿流改道的临床效果。方法 1993年6月-2012年6月行Sigma直肠膀胱术45例,以乙状结肠直肠交界点为中点,纵行剖开肠管20～24 cm,折叠缝合成形为储尿囊。输尿管经黏膜下隧道与肠道吻合,肛门括约肌控制排尿。术后随访6个月～19年,平均6年。分析术后控尿情况,储尿囊压力测定,上尿路并发症,用国际前列腺症状评分表的生活质量（Quality of Life,QOL）指数问卷表评价患者排尿对生活质量的满意度。结果控尿情况：术后早期控尿40例不同程度尿失禁。术后30 d肛门能有效控制排尿,手术后6个月~15年病例均能控尿。储尿囊容量270～600 ml,平均375 ml。充盈期基础压力6～20 cmH2O,最大充盈压力15～30cmH2O,平均26 cmH2O。储尿囊顺应性良好。上尿路并发症,单侧肾积水6例,均为轻度。长期效果无代谢性酸中毒、无逆行肾盂感染等严重并发症的病例。患者QOL评分20例为0~2分,5例3分,2例4分。结论 Sigma直肠膀胱术具有手术操作较简单,患者易接受,对同时行尿道切除的患者是一种较理想的可控性尿流改道方法。Objective Our goal was to summarize clinical effects of sigmoidorectal pouch for urinary diversion.Methods Forty-five patients underwent sigmoidorectal pouch procedure in our hospital from June 1993 to June 2012.Operation was performed as follows.We took the boundary spot between sigmoidal colon and rectum as midpoint,split intestinal canal lengthwise over 20～24 cm,and sutured it to form a low-pressure reservoir.The ureters were shunt with intestinal tract by means of submucosal tunnel technique,and the anal sphincter was used to control urination.The patients were followed up for 6 months to 15 years after operation.The index of quality of life in the International Prostate Symptom Score（IPSS） was used to evaluate the degree of satisfaction to urinate.Result Forty patients had slight incontinence in the early postoperative stage,and could control urination well 30 days postoperatively.The volume of pouch was 270~600 ml,with an average of 375 ml.The basic pressure during filling period was 6~20 cmH2O with an average 15 cmH2O,and the maximum filling pressure was 15~30 cmH2O with an average 26 cmH2O.The compliance of sigmoidorectal pouch was fine.There were no severe complications such as hyperchlorine acidosis or retrograde pyelonephritis.Six patients had slight hydronephrosis.The index of QOL were 0~2 in twenty patients,3 in five patients and 4 in two patients respectively.Conclusion The sigmoidorectal pouch operation is simple and acceptable by surgeons and patients.It was an ideal urinary diversion for patients with muscle-invasive bladder cancer,especially for patients who received urethrectomy.

关 键 词：膀胱肿瘤 尿流改道 乙状结肠直肠膀胱术 

分 类 号：R737.14[医药卫生—肿瘤]