单双段回肠Yang-Monti管术膀胱可控性流出道在尿道损毁患者中应用的对比研究  

Comparative study of single and double ileal Yang-Monti duct controllable outflow tract in patients with urethral damage

作　　者：陈爽[1] 彭聊 范旸 沈宏[1] 罗德毅[1] Chen Shuang;Peng Liao;Fan Yang;Shen Hong;Luo Deyi(Department of Urology,Institute of Urology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院泌尿外科泌尿外科研究所,成都610041

出　　处：《中华泌尿外科杂志》2022年第8期570-574,共5页Chinese Journal of Urology

摘　　要：目的探讨Yang-Monti管术膀胱可控性流出道治疗尿道损毁患者的有效性和安全性,比较单段与双段回肠管的应用效果。方法回顾性分析四川大学华西医院2009年1月至2018年2月收治的27例行Yang-Monti管术患者的临床资料,其中采用单段回肠14例(单段组),双段回肠13例(双段组)。单段组和双段组的年龄分别为(56.5±4.3)岁和(50.2±6.8)岁(P=0.220),男/女分别为2/12例和3/10例(P=0.564),体质指数分别为(19.6±1.3)kg/m^(2)和(24.2±2.1)kg/m^(2)(P<0.001),病程分别为6(3~24)个月和8(3~48)个月(P=0.650),术前生活质量(QOL)评分分别为(46.7±1.7)分和(45.5±1.7)分(P=0.061),术前发生尿路感染例数分别11例和13例(P=0.480)。单段组2例伴高血压病。单段组距回盲部约15 cm处截取2 cm带系膜血管的回肠,沿对系膜缘肠管走行方向纵行切开,将肠片横行包绕F12尿管并用3-0单乔线间断缝合卷成Yang-Monti管。于膀胱顶壁偏前外侧切开膀胱壁长约1 cm,将Yang-Monti管与膀胱壁黏膜肌层端端吻合。于髂前上棘水平腹直肌处做直径约1 cm圆形切口,用弯钳穿刺入腹形成隧道,将Yang-Monti管沿隧道引出腹壁,管口与皮下缝合固定,同时于腹腔内将管壁用4-0丝线固定于腹膜。双段组截取2段2.0 cm回肠,沿对系膜缘肠管走行方向纵行切开肠管后,先将肠片端端缝合后再卷管重建,形成直径0.6~0.8 cm、长径约12.0 cm的Yang-Monti管,将Yang-Monti管近端与膀胱黏膜肌层直接间断吻合。比较两组的手术时间、术中出血量、术后导尿间隔、术后单次导尿量、术后并发症(出血、肠梗阻、吻合口瘘、吻合口狭窄、造口感染、尿路感染)和QOL评分等。结果两组手术均顺利完成。单段组和双段组的手术时间分别为(165.8±17.8)min和(157.54±12.25)min(P=0.302),术中出血量分别为(60.0±20.0)ml和(50.0±25.0)ml(P=0.650),术后恢复进食时间分别为3(2~4)d和3(2~9)d(P=0.790),术后住院时间分别为12(9~40)d和12(10~3Objective To evaluate the efficacy and safety of Yang-Monti tube in the operation of bladder controllable outflow tract,and to compare the efficacy of single and double segments Yang-Monti tube in patients with urethral damage.Methods The clinical data of 27 patients who underwent Yang-Monti tube surgery in West China Hospital of Sichuan University from January 2009 to February 2018 were retrospectively analyzed,including 14 cases of single segment ileum(single segment group)and 13 cases of double segment ileum(double segment group).The age of single-segment group and double-segment group was(56.5±4.3)years and(50.2±6.8)years,respectively(P=0.220).There were 2/12 and 3/10 males and females,respectively(P=0.564).The body mass index(BMI)was(19.6±1.3)kg/m^(2) and(24.2±2.1)kg/m^(2),respectively(P<0.001).The disease duration was 6(3-24)months and 8(3-48)months,respectively(P=0.650).The preoperative quality of life(QOL)score was(46.7±1.7)and(45.5±1.7),respectively(P=0.061).The number of patients with urinary tract infection before operation was 11 and 13,respectively(P=0.480).In the single-segment group,a 2 cm ileum with mesangial vessels was cut at a distance of about 15 cm from the ileocecal part,and the intestine was cut longitudinally along the direction of the intestinal canal at the opposite mesangial margin.The intestinal piece was wrapped horizontally around the F12 urinary tube and wound into a Yang-Monti tube by intermittent suture with a 3-0 single thread.The bladder wall was cut anterolateral to the top wall of the bladder,about 1 cm in length,and the Yang-Monti tube was anastomosed end-to-end with the mucosal muscularis of the bladder wall.A circular incision with a diameter of about 1 cm was made at the level of the anterior superior iliac spine at the rectus abdominis muscle,and a tunnel was formed by puncture into the abdomen with curved forceps.The Yang-Monti tube was led out of the abdominal wall along the tunnel,and the tube opening was fixed with subcutaneous suture.At the same time,the tube w

关 键 词：尿流改道术 Yang-Monti管 可控性 肠段 生活质量 

分 类 号：R699.6[医药卫生—泌尿科学]