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目的:总结膀胱全切原位回肠新膀胱术后行膀胱镜检查的方法技巧及注意事项。方法:回顾性分析2011年5月~2015年3月膀胱全切原位回肠新膀胱术(开放或腹腔镜手术)术后行膀胱镜检查的56例患者资料,男50例,女6例。年龄51~76岁,平均63岁。其中带膀胱造瘘管者30例,不带膀胱造瘘管者26例。采用Wolf硬性膀胱镜,直视下进镜,必要时进入输尿管支架管引导通过新膀胱尿道吻合口。进镜后带膀胱造瘘管者经造瘘管进入F12吸痰管连接负压吸引吸净新膀胱内肠道分泌物后观察操作;不带膀胱造瘘管者经膀胱镜镜桥器械孔进入F6吸痰管连接负压吸引吸净新膀胱内肠道分泌物后观察操作。结果:56例患者均顺利进镜,观察、操作过程顺利。检查结束后排尿通畅,无穿孔及严重血尿、疼痛等并发症。结论:对于原位回肠新膀胱术后患者行膀胱镜检查操作时,采用直视下进镜,必要时配合输尿管支架管引导能够提高进镜成功率,减少尿道及新膀胱的损伤;进镜后应用负压吸引装置吸净新膀胱内肠道分泌物然后观察操作能够保证观察视野清晰,提高操作成功率。
OBJECTIVE: To summarize the methods and precautions of cystoscopy after bladder resection of ileal neo-bladder. Methods: The data of 56 patients undergoing cystoscopy after open excision of bladder ileum (open or laparoscopic surgery) from May 2011 to March 2015 were retrospectively analyzed. There were 50 males and 6 females. Age 51 to 76 years old, average 63 years old. Among them, there were 30 cases with cystostomy tube and 26 cases without cystostomy tube. The use of Wolf rigid cystoscopy, direct vision into the mirror, if necessary, enter the ureteral stent tube through the new bladder and urethra anastomosis. Into the mirror with bladder fistula after fistula into the F12 suction tube connected to the negative pressure to attract the net absorption of the new intestinal secretions observed after operation; without cystostomy tube through the cystoscope mirror instrument hole into the F6 suction Negative pressure to attract suction pipe net absorption of the new intestinal secretions observed after the operation. Results: 56 patients were successfully into the mirror, observation, the operation was smooth. Urine clear after examination, no perforation and severe hematuria, pain and other complications. CONCLUSIONS: For patients undergoing neo-bladder surgery after cystoscopy, under direct vision into the mirror, when necessary with ureteral stent guide can improve the success rate into the mirror to reduce the urethra and neo-bladder injury; into the mirror Application of negative pressure suction device to absorb the secretions of the new urinary bladder intestine and then observe the operation to ensure a clear field of vision and improve the success rate of operation.