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目的:综合评价膀胱全切改良MainzⅡ尿液转流术的临床效果。方法:对31例膀胱根治性切除患者行改良MainzⅡ尿液转流术,即乙状结肠及直肠“N”形折叠缝合去管囊化形成低压肠袋,分别于术后3个月、6个月、1年、2年、3年、4年、5年监测肾功能、血电解质和输尿管、肾盂反流及上尿路并发症,同时作肿瘤患者生活质量评价(QOL)。结果:全组手术顺利,手术时间180～240 min,平均210 min,失血量200～1400 ml,平均370ml。随访6～60个月,1例术后10天出现肠漏(尿粪漏),经留置盆腔引流管(经尿道置入),加强肛管引流而愈;3例膀胱肿瘤复发,术后8～24个月因肿瘤复发转移死亡;余28例恢复良好。术后综合评估结果:①上尿路并发症(>3个月):3例上尿路感染7次,经抗感染治愈;3例一侧、1例两侧肾盂轻度扩张,经观察未加重,1例一侧肾盂中度扩张,正在观察中;输尿管、肾盂反流:4例贮尿囊造影无输尿管、肾盂反流。②生化检查:死亡的3例患者在晚期多项生化指标有不同程度异常;上尿路感染的3例在急性期尿素氮、血肌酐、尿酸有轻中度升高,其余25例肾功能、血钾、血钠、血氯、血浆二氧化碳结合力均正常,无高氯血症、代谢性酸中毒。③控尿率:3个月后昼夜静息及日常活动时的尿液均可控,控尿率为100%。④夜尿次数:3个月后,晚11时到次日晨7时夜尿1～3次,尿粪可分开排泄,尿量320～550 ml,平均410 ml。⑤QOL评分:本组38～52分,平均45分,生活质量较好。结论:改良MainzⅡ尿液转流术较易操作,并发症少,生活质量较高,接近正常生理,有仿生学意义,是医患双方均易于接受的术式。
Objective: To evaluate the clinical effect of total curatively modified Mainz Ⅱ urinary diversion. Methods: Thirty-one patients with radical curative resection were treated with modified Mainz II uroflow diversion, ie, sigmoid colon and rectum “N” fold suture to form low-pressure intestinal pouch. After 3 months and 6 months Month, 1 year, 2 years, 3 years, 4 years, 5 years monitoring of renal function, blood electrolyte and ureter, pyelonephrosis and upper urinary tract complications, while for cancer patients quality of life assessment (QOL). Results: All the operations were successful. The operation time ranged from 180 to 240 minutes with an average of 210 minutes and the blood loss ranged from 200 to 1400 ml with an average of 370 ml. Followed up for 6 to 60 months, one case of intestinal leakage (urine leakage) occurred 10 days after the operation, after placement of pelvic drainage tube (transurethral placement), to strengthen the drainage of the anal canal and more; 3 cases of bladder tumor recurrence, postoperative 8 ~ 24 months due to tumor recurrence and metastasis; more than 28 cases recovered well. Postoperative comprehensive assessment results: ① upper urinary tract complications (> 3 months): 3 cases of upper urinary tract infection 7 times cured by anti-infection; 3 cases of side, 1 case of bilateral renal pelvis mild dilatation, Increased, 1 case of moderate renal pelvis dilatation, is under observation; ureter, renal pelvis reflux: 4 cases of urine storage catheter without ureter, renal pelvis reflux. Biochemical tests: three patients died in the late biochemical indicators have varying degrees of abnormalities; upper urinary tract infection in 3 cases of acute urea nitrogen, serum creatinine, uric acid mild to moderate increase in the remaining 25 cases of renal function, Blood potassium, blood sodium, blood chlorine, plasma carbon dioxide binding were normal, no hyperchloremia, metabolic acidosis. ③ control the rate of urine: 3 months after the day and night rest and daily activities of urine are controllable, urine control rate was 100%. ④ nocturia times: 3 months later, 11 pm to 7 am the next morning urine 1 to 3 times, urine excretion can be excreted, urine output 320 ~ 550 ml, an average of 410 ml. ⑤ QOL score: 38 to 52 points in this group, an average of 45 points, better quality of life. Conclusion: The modified Mainz Ⅱ urinary diversion is easy to operate, with fewer complications and higher quality of life, close to normal physiology, and has bionomics significance. It is an acceptable procedure for both doctors and patients.