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目的:探讨改良式烟筒形回肠输尿管末端吻合法在可控W形回肠新膀胱术中的应用和疗效。方法:对62例膀胱全切除术后可控W形回肠新膀胱术的患者,实施了改良式烟筒形回肠与输尿管末端吻合。其中12例肠系膜过短者进一步游离肛门侧的回肠,未去管化直接拉进盆腔与尿道吻合。结果:本组手术时间平均为300min,术中出血量平均为500 mL;术后随访24个月,平均16个月,失访19例,死亡8例。术后1年膀胱容量平均为500 mL,残余尿量平均为0～50 mL;术后1个月内,发生肾积水8例14个肾(11.3%),但3个月后全部消失、短暂性新膀漏尿6例(9.7%)、急性肾盂肾炎4例(6.5%)、尿道狭窄5例(8.1%),经对症治疗好转。结论:改良式烟筒形回肠与输尿管末端吻合法及未去管化的肛门侧回肠与尿道吻合法,手术时间短,出血和并发症少,控尿效果好,尤其在肠系膜过短者效果良好,值得推广。
Objective: To investigate the application and curative effect of modified end-to-end ureteral ileal ureter in controllable W-shaped ileal neo-bladder surgery. Methods: Sixty-two patients with controlled W-shaped ileal neo-bladder surgery after total cystectomy were performed anastomosed modified tubular ileum and ureter. Among them, 12 cases of mesenteric shortened further free anus side of the ileum, not to the tube directly into the pelvis and urethra anastomosis. Results: The average operation time in this group was 300 min. The average amount of blood loss during operation was 500 mL. The average follow-up time was 24 months (average 16 months). There were 19 patients lost to follow-up and 8 died. One year after operation, the average volume of bladder was 500 mL and the residual urine volume was 0 ~ 50 mL on average. Within one month after operation, 8 cases of 14 kidneys (11.3%) developed hydronephrosis, but all disappeared after 3 months. Six cases (9.7%) of transient neovascular leakage, four cases of acute pyelonephritis (6.5%), and five cases of urethral stricture (8.1%) were treated with symptomatic treatment. Conclusions: The improved anastomosis of tubular ileum and ureter with anastomosis and unmanaged anastomosis of anus and ipsilateral urethra with short operation time, less bleeding and complications, good effect of controlling urine, especially in the case of mesenteric short, Worth promoting.