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膀胱肿瘤等需要行膀胱全切的疾病日趋增多,膀胱全切后可控性尿流改道的应用日益广泛,尿流改道的手术方式多种多样。到目前为止,膀胱全切术后的尿流改道尚无标准的术式,理想的替代膀胱应接近正常的生理功能,维持一定的排尿时间间隔,尿控良好,并发症少。乙状结肠直肠膀胱术(改良Mainz pouchⅡ),将双侧输尿管再植于去管状化的乙状结肠直肠储尿囊,术后利用肛门括约肌控制排尿。该手术时间短,出血少,操作方便,对肠管扰动小,术后尿控、排空满意,肾盂肾炎、代谢性酸中毒等并发症少。所有患者在2~3个月以后能将大小便分开,患者不需要佩戴集尿袋或间断性导尿,生活可以自理,生活质量明显得到改善;因此,是一种比较好的可控性尿流改道方法。本文就近年来的研究进行分析总结,希望经过进一步的改良,改良MainzⅡ术式成为尿流改道中非常重要的方式之一,在特定的情况下会替代其他类型的尿流改道。
Bladder cancer and other needs of the line to cut the growing number of bladder diseases, control of the bladder after complete cutting of urinary diversion is increasingly widespread, diversion of the urinary diversion of a variety of ways. So far, urinary diversion after total cystectomy there is no standard surgical procedures, the ideal alternative bladder should be close to normal physiological function, to maintain a certain urinary interval, urinary control is good, less complications. Sigmoid colon and rectocele (modified Mainz pouch II), bilateral ureter replanted in de-tubular sigmoid colon, the use of anal sphincter control urination. The operation time is short, less bleeding, easy operation, small disturbance to the intestine, postoperative urine control, emptying satisfaction, pyelonephritis, metabolic acidosis and other complications less. All patients were able to separate the urine and urine after 2 to 3 months. The patients did not need to wear a urine bag or intermittent catheterization, and they could take care of themselves and their quality of life improved obviously. Therefore, it was a good controllable urine Flow diversion method. This article analyzes and summarizes the researches in recent years. It is hoped that after the further improvement, the modified Mainz II procedure will become one of the most important ways to divert urinary flow, and will replace other types of urinary diversion in certain circumstances.