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目的 评价改良Sigma术式可控性尿流改道的临床疗效。 方法 对 14例膀胱、前列腺肿瘤患者采用改良Sigma术式。折叠乙状结肠约 2 5cm后全层切开 ,再缝合成低压袋 ,顶端固定在骶岬处 ,两输尿管末端合并吻合并外翻形成乳头 ,从低压袋上方引入再植。 结果 全膀胱切除后的直肠膀胱术平均手术时间 6 5min。术后 1例发生直肠阴道瘘 ,经横结肠造口后瘘口自愈 ;1例左肾积水伴上尿路感染者经输尿管顺行扩张后恢复正常 ,患者术后 3个月发生低血钾 ,补充枸橼酸钾后治愈。全组无尿失禁、肾功能损害及严重上尿路感染等并发症。 结论 改良Sigma手术时间短 ,对肠管扰动小、操作简便 ,术后尿控满意 ,上尿路积水、感染、电解质紊乱等并发症少 ,可明显提高患者生活质量。
Objective To evaluate the clinical efficacy of modified sigma controlled urinary diversion. Methods Modified sigma was performed on 14 patients with bladder and prostate tumors. Fold the sigmoid colon about 25cm after full-thickness incision, and then synthesize low-pressure bag, the top fixed in the ankle, the two ends of the ureter with anastomosis and valgus to form a nipple, replanted from the top of the low pressure bag. Results The average operative time of rectal cystectomy after total cystectomy was 6 5min. One case developed rectovaginal fistula, and the fistula was self-healed after transverse colostomy; one case of left hydronephrosis with upper urinary tract infection returned to normal after ureteral dilatation and hypokalemia occurred 3 months after operation. , It is cured after adding potassium citrate. There were no complications such as incontinence, renal impairment, and severe upper urinary tract infection. Conclusions Modified Sigma has a short operation time, little disturbance to the intestinal tract, simple operation, satisfactory postoperative urinary control, less complications such as hydrops, infection, and electrolyte disorders in the upper urinary tract, which can significantly improve the quality of life of patients.