腹腔镜全膀胱切除回肠膀胱术中输尿管引流的策略  

Ureteral drainage strategy in laparoscopic radical cystectomy and ileal cystoplasty

作　　者：曹君[1] 叶昶[1] 余伟民[1] 饶婷[1] 程帆[1] 张孝斌[1] 

机构地区：[1]武汉大学人民医院泌尿外科

出　　处：《临床外科杂志》2015年第8期606-608,共3页Journal of Clinical Surgery

摘　　要：目的探讨腹腔镜全膀胱切除回肠膀胱术（Bricker）中不同输尿管引流方法的临床效果。方法采用Bricker术治疗膀胱癌患者126例。输尿管支架引流管的应用包括双J管引流（A组）37例，咫吸痰管引流（B组）47例，单J管引流（C组）42例。对输尿管支架引流管相关资料进行比较。结果A组5例输尿管代膀胱吻合口漏尿，4例充分引流后好转，1例引流后仍无好转，局部探查重新吻合后恢复。输尿管代膀胱吻合口不全狭窄A组和B组各1例。术后A组普通留置的双J管于膀胱镜下拔除，2例出现一侧双J管回缩的患者采用经皮。肾通道拔除，尾部留有丝线的患者直接在丝线的牵拉下拔除双J管，其中8侧出现丝线断裂或撕脱，改由膀胱镜拔管。B组将固定在代膀胱引流管上的输尿管支架管同代膀胱引流管一并拔除。C组拔除情况同B组，拔管过程均顺利。结论不同的输尿管支架管引流策略对术后的恢复和后期处理具有显著的影响，代膀胱外引流较膀胱内引流具有明显的优势。Objective To evaluate the clinical efficacy of different ureteral drainage in laparoscopic radical cystectomy and ileal cystoplasty（ Bricker＇s surgery）. Methods A total of 126 cases of bladder tumor received Bricker＇s surgery. Application of ureteral stents included double J tube in 37 cases （ Group A） ,F8 suction tube in 47 cases（ Group B） ,and single J tube in 42 cases（ Group C）. The related data of ureteral drainage were collected and analyzed. Results Ureteral anastomosis leak was found in five eases in Group A. Four cases were improved after adequate drainage and one case was improved after a local exploration for rematch. Each of group had one case of incomplete anastomotic stricture. In Group A, the indwelling double J tube were postoperatively removed under cystoscope. The double J tubes in two cases with one-sided retraction were removed by percutaneous renal access. In patients with tail thread on double J tube, the tube was directly removed by traction. Eight sides of them had avulsed or fractured thread,and their tubes were removed by cystoscopy. In Group B, the ureteral stent and bladder drainage tube were removed. Tubes in Group C were smoothly removed as Group B. Conclusion Different ureteral stent drainage strategies have significant impacts on postoperative recovery and post-processing, and external drainage has more advantage than the internal drainage.

关 键 词：膀胱肿瘤 腹腔镜 全膀胱切除 输尿管引流 

分 类 号：R737.14[医药卫生—肿瘤]