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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,F8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 investigate the clinical effects of different ureteral drainage methods in laparoscopic total cystectomy (Bricker). Methods 126 patients with bladder cancer were treated with Bricker technique. The application of ureteral stent drainage tube included 37 cases of double J tube drainage (group A), 47 cases of F8 suction tube drainage (group B) and 42 cases of single J tube drainage (group C). Ureteral stent drainage tube related information to compare. Results A group of 5 cases of ureter on behalf of the anastomotic leakage of the bladder, 4 cases of full drainage improved, 1 case did not improve after drainage, local exploration re-anastomosis recovery. Ureteral on behalf of the anastomotic incompetent stenosis A group and B group in 1 case. Postoperative A group of common indwelling double J tube removed under cystoscopy, two cases of bilateral J-tube retraction on one side of the patients with percutaneous renal removal, the remaining patients with silk thread pulled directly in the wire under the double J tube, of which 8 side of the wire breakage or avulsion, replaced by cystoscopy extubation. Group B will be fixed on behalf of the bladder drain catheter tube with the same removal of the same drainage tube. C group with the removal of B group, extubation process are smooth. Conclusions Different ureteral stent drainage strategies have a significant effect on postoperative recovery and postoperative management. Out-of-bladder drainage has more advantages than intravesical drainage.