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目的:尝试采用可控性尿路改道术治疗因外伤、手术后并发症而导致的膀胱颈部后尿道狭窄闭塞、膀胱挛缩、肾盂输尿管返流以及严重尿失禁。方法:对于膀胱容量基本正常者,采用膀胱前壁肌瓣形成肌管斜行通过腹直肌的方式,形成膀胱可控性造口;对于膀胱颈部后尿道狭窄闭塞、膀胱挛缩、肾盂输尿管返流者,采取阑尾原位脐造口可控性肠代膀胱术,输尿管与肠代膀胱粘膜下隧道吻合,旷置原来的膀胱和尿道。结果:两种术式术后患者膀胱或肠代膀胱均控尿能力良好,造瘘口无须覆盖,未发生感染。患者自我插管方便顺利。结论:可控性尿路改道不仅适用于中晚期的膀胱肿瘤患者的膀胱替代,也可以用于下尿路功能严重障碍者膀胱和尿道的暂时性或永久性替代。
OBJECTIVE: To try to control the posterior urethral stricture occlusion, bladder contracture, ureteropelvic reflux and severe urinary incontinence caused by trauma and postoperative complications with controlled urinary diversion. Methods: For patients with normal bladder volume, the anterior bladder wall was used to form myotube obliquely through the rectus abdominis to form a controllably stoma for the bladder. For bladder neck posterior urethral stricture occlusion, bladder contracture and ureteropelvic reflux Flow, to take the control of the umbilical ostomy in situ appendix in the generation of bladder, ureter and intestinal submucosal tunnel anastomosis, exclusion of the original bladder and urethra. Results: The two kinds of postoperative patients with urinary bladder or bladder were able to control urinary bladder good capacity, no need to cover the fistula, no infection. Patients self intubation convenient and smooth. CONCLUSIONS: Controlled urinary diversion is not only suitable for bladder replacement in patients with advanced bladder cancer, but also for transient or permanent bladder and urethral replacement in patients with severe lower urinary tract dysfunction.