带蒂大网膜包裹输尿管皮肤造口术的临床应用  

The clinical application of wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy

作　　者：韩精超[1] 夏溟 杨飞亚[2] 王明帅[2] 贺庆豹 宋黎明[2] 瓦斯里江·瓦哈甫[2] 邢念增[2] Han Jingchao;Xia Ming;gang Feiya;Wang Mingshuai;He Qingbao;Song Liming;Wasilijiang Wahafu;Xing Nianzeng(Department of Urology,Belting Shifitan Hospital,Capital Medical University ,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院泌尿外科,100038 [2]首都医科大学附属北京朝阳医院泌尿外科

出　　处：《中华泌尿外科杂志》2018年第7期505-508,共4页Chinese Journal of Urology

摘　　要：目的探讨带蒂大网膜包裹输尿管皮肤造口术在根治性膀胱切除术尿流改道中的临床应用效果。 方法回顾性分析2016年1月至2017年9月收治的12例膀胱癌患者的临床资料，男7例，女5例。年龄75～83岁，平均77岁。病程5 d～2年。临床表现为肉眼血尿11例，尿频、尿急5例，下腹疼痛1例；无明显临床症状1例。9例有经尿道膀胱肿瘤切除术史。合并高血压病8例，糖尿病5例，心脑血管疾病7例，贫血6例。术前美国麻醉师协会评分3分9例，4分3例。所有患者术前均经膀胱镜检查并取活检，病理证实均为膀胱尿路上皮癌。临床分期T3期8例，T4期4例。12例均全麻下行腹腔镜根治性膀胱切除术，尿流改道采用带蒂大网膜包裹输尿管皮肤造口术。取宽3～5 cm血供良好的带蒂大网膜，将大网膜从游离的输尿管近端向输尿管末端覆盖，并用4-0可吸收线将大网膜与输尿管外膜固定，然后行输尿管皮肤造口。观察术后吻合口狭窄、肾积水及伤口感染等并发症的发生率。 结果12例手术均顺利完成，手术时间95～217 min，平均125 min。术中出血量50～600 ml，平均120 ml。术后5 d 1例出现切口感染，经加强抗感染、换药治疗痊愈。无尿瘘、肠瘘、造口周围疝等并发症发生，无围手术期死亡病例。术后1～3个月拔除单J管。术后随访3～23个月，平均12个月，1例出现输尿管造口乳头轻度回缩塌陷，未行特殊处理；1例术后3个月因脑梗死死亡；余10例未发生输尿管末端狭窄、坏死，无肾积水病例，患者对术后生活质量满意。 结论在根治性膀胱切除尿流改道中应用带蒂大网膜包裹输尿管皮肤造口术的操作简单、安全，并发症少，效果良好。ObjectiveTo discuss the effect and value of wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy as urinary diversion after radical cystectomy.MethodsThe clinical data of 12 cases（7 males and 5 females）with bladder cancer during January 2016 and September 2017 were retrospectively analyzed.The median age was 77 years（range 75-83 ）, and the course of the disease was 5 days to 2 years. 11 cases had gross hematuria, 5 cases had frequent and urgent urination, 1 case had lower abdominal pain, and 1 case had no obvious clinical symptoms.9 cases had a history of transurethral prostatic resection. 8 cases had a complication of hypertension, 5 cases had a complication of diabetes, 7 cases had a complication of cardiovascular and cerebrovascular diseases, and 6 cases had a complication of anemia. The ASA level was 3 in 9 cases and was level 4 in 3 cases.All the patiants were diagnosed of bladder urothelial carcinoma by biopsy. There were 8 cases with T3 tumor and 4 cases with T4.All the patients underwent laparoscopic radical cystectomy under general anesthesia, and wrapping ureter by a pedicled gastrocolic omentum flap during cutaneous ureterostomy was used for urinary diversion.Take a segment of 3-5 cm wide pedicle omentum, which is covered from the distal end of the ureter to the end, and use a 4-0 absorbable line to fix the omentum and ureteral outer membrane, and then perform ureterocutaneostomy. The incidence of postoperative anastomotic stenosis, hydronephrosis and wound infection were observed.ResultsAll the operations were performed successfully without obvious operative complications.The mean operating duration was125（95-217）mins, estimated volume of blood loss 120（50-600）ml. 5 days after surgery, 1 patient developed incision infection, which was cured by strengthening anti-infection drug therapy and wound dressing. No complications such as urinary fistula, intestinal fistula and peripheral hernia occurred. No death was reported during perioperative period.Single J

关 键 词：膀胱癌 尿流改道 输尿管皮肤造口 大网膜 

分 类 号：R737.14[医药卫生—肿瘤]