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目的总结Sigma直肠膀胱术尿流改道的临床效果。方法 1993年6月-2012年6月行Sigma直肠膀胱术45例,以乙状结肠直肠交界点为中点,纵行剖开肠管20～24 cm,折叠缝合成形为储尿囊。输尿管经黏膜下隧道与肠道吻合,肛门括约肌控制排尿。术后随访6个月～19年,平均6年。分析术后控尿情况,储尿囊压力测定,上尿路并发症,用国际前列腺症状评分表的生活质量(Quality of Life,QOL)指数问卷表评价患者排尿对生活质量的满意度。结果控尿情况:术后早期控尿40例不同程度尿失禁。术后30 d肛门能有效控制排尿,手术后6个月~15年病例均能控尿。储尿囊容量270～600 ml,平均375 ml。充盈期基础压力6～20 cmH2O,最大充盈压力15～30cmH2O,平均26 cmH2O。储尿囊顺应性良好。上尿路并发症,单侧肾积水6例,均为轻度。长期效果无代谢性酸中毒、无逆行肾盂感染等严重并发症的病例。患者QOL评分20例为0~2分,5例3分,2例4分。结论 Sigma直肠膀胱术具有手术操作较简单,患者易接受,对同时行尿道切除的患者是一种较理想的可控性尿流改道方法。
Objective To summarize the clinical effect of urinary diversion in sigmoid rectovaginal bladder surgery. Methods From June 1993 to June 2012, 45 patients underwent sigmoid rectovaginal catheterization. The sigmoid colorectal junction was taken as the midpoint. The intestine was dissected longitudinally for 20-24 cm. Transurethral ureter through the submucosal anastomosis with the intestine, anal sphincter control urination. Follow-up 6 months to 19 years, an average of 6 years. Urinary control, storage pressure and upper urinary tract complications were analyzed. The quality of life (QOL) of the patients was evaluated by QOL (Quality of Life, QOL) questionnaire. Urinary control results: early postoperative urinary incontinence in 40 cases of varying degrees. Anus 30 days after surgery can effectively control urination, 6 months after surgery to 15 cases were able to control urine. Storage of urine volume 270 ~ 600 ml, an average of 375 ml. Filling period of the basic pressure of 6 ~ 20 cmH2O, the maximum filling pressure of 15 ~ 30cmH2O, with an average of 26 cmH2O. Storage urinary bladder compliance is good. Upper urinary tract complications, unilateral hydronephrosis in 6 cases, were mild. Long-term effects No metabolic acidosis, no serious complications such as retrograde pyelonecrosis cases. Patients QOL score 20 cases were 0 to 2 points, 5 cases 3 points, 2 cases 4 points. Conclusion Sigma sigmoid surgery has the advantages of simple operation and easy-to-accept operation. It is an ideal controllable urinary diversion method for patients undergoing simultaneous urethral resection.