低张力Roux-Y乙状结肠尿流改道抗返流瓣抗粪逆流的实验研究  

The Effect of Antireflux Valve Resisting Fecal Countercurrent after Urinary Diversion by Low Tension Roux- Y Sigmoid Neo- bladder

作　　者：王健[1] 刘定益[1] 夏维木[2] 许天愿 俞家顺 李文敏[1] 陈荣国[1] 王萍[1] 唐崎[1] 

机构地区：[1]上海市浦东新区浦南医院,上海浦东新区200125 [2]中国人民解放军第184医院,江西鹰潭335000 [3]上海交通大学医学院附属瑞金医院,上海200025

出　　处：《河北医学》2016年第2期184-187,共4页Hebei Medicine

基　　金：上海市浦东新区科委课题;编号:(PKJ2011-Y20)

摘　　要：目的：研究不同形式抗返流瓣抗粪逆流效果,减少低张力Roux-Y乙状结肠尿流改道术后并发症的发生。方法：将18只比格犬随机分成三组,切除膀胱后行低张力Roux-Y乙状结肠尿流改道,其中为Ⅰ组为无抗返流瓣组（n=6）、Ⅱ组为前壁抗返流瓣组（n=6）、Ⅲ组为套叠式抗返流瓣组（n=6）。术后观察排尿情况,12周后行排泄性尿路造影及＂新膀胱＂、直肠压力测试。结果：术后一月恢复每1.5-2.5h肛门排尿1次,排尿前尿液主要储存在直肠壶腹部,单次排尿量各组无明显差异。术后各组＂新膀胱＂静息压无明显差异,套叠组（Ⅲ组）顺流压和前壁组（Ⅱ组）相比无明显差异（P〉0.05）,但套叠组（Ⅲ组）抗逆流压高于前壁组（Ⅱ组）和无抗返流瓣组（Ⅰ组）（P〈0.05）;肛门溢尿时＂新膀胱＂压,无抗返流瓣组（Ⅰ组）明显高于前壁组（Ⅱ组）和套叠组（Ⅲ组）（P〈0.05）。结论：低张力＂新膀胱＂具有一定的压力缓冲作用,套叠式抗返流瓣抗粪逆流作用优于前壁抗返流瓣。Objective： To study different antireflux valve effects of resisting fecal countercurrent,and to reduce complications after uninary diversion with low tension Roux- Y sigmoid neo- bladder. Method： 18 Beagle dogs were randomly divided into three groups,and received low tension Roux- Y sigmoid urinary diversion after resection of bladder. GroupⅠrefered to no anti- reflux valve group（ n = 6）,Group Ⅱwas anterior wall anti reflux valve group（ n = 6）,and Group Ⅲ was intussusception antireflux valve（ n = 6）. Uri nation was observed after operation. Excretory urography was operated,and manometry of anorectal and neo-bladder was used 12 weeks later. Result： Anal urination was recovered to once per 1. 5 - 2. 5h about one month later. Urine was mainly stored in rectal ampulla before voiding. Single volume had no significant differences among three groups. The resting pressure of neo- bladder in each group had no significant differences. So did the downstream pressure in the Intussusception Group（ Group Ⅱ） compared with the Anterior Group（ Group Ⅱ）（ P〈 0. 05）; the upstream pressure in Group Ⅲ was higher than that in Group Ⅱand Group I（ P〈 0. 05）; when urine was overflowed out of anal, ＂ neo- bladder＂ pressure in Group I was significantly higher than that in GroupⅡand Group Ⅲ（ P〈 0. 05）. Conclusion： Low tension ＂neobladder＂has stress- buffering effect,and intussusception antireflux valve resists fecal countercurrent better than anterior antireflux valve.

关 键 词：尿流改道 改良输尿管乙状结肠吻合 抗返流瓣 肛管直肠测压 动物实验 

分 类 号：R699.6[医药卫生—泌尿科学]