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目的探讨去带盲升结肠可控膀胱术后远期并发症的发生及防治。方法回顾性分析1995年10月至2003年1月105例去带盲升结肠可控膀胱术后患者资料。男83例,女22例。年龄32~78岁,平均60岁。随访时间9~82个月,平均40.5个月。结果发生远期并发症27例(25.7%),其中导尿插管困难4例(3.8%),3例行尿道扩张后治愈,1例再次手术利用末段回肠重建输出道;贮尿囊结石5例(4.8%),4例行贮尿囊切开取石治愈,1例无自觉症状者未行处理;贮尿囊穿孔1例(0.9%),行手术修补后痊愈;贮尿囊过度扩张1例(0.9%),行贮尿囊缩小术;肾积水8例(7.6%),合并输尿管返流1例,合并下段输尿管狭窄4例,其中2例行狭窄段输尿管切除再吻合,1例术前为氮质血症者发展为尿毒症需行规律血透;血氯增高7例(6.7%),1例出现高氯性酸中毒需长期口服碳酸氢钠;单纯表现为症状性泌尿系感染1例(0.9%)。27例中另合并症状性泌尿系感染10例,根据尿培养结果予敏感抗生素治愈。结论去带盲升结肠可控膀胱术后远期并发症多与症状性泌尿系感染相关,积极防治泌尿系感染,规律、充分的贮尿囊冲洗及定时清洁导尿对远期并发症的预防有重要作用。
Objective To investigate the long-term complications of blind ascending colon controllable bladder surgery and prevention and treatment. Methods A retrospective analysis of 105 patients with blind ascending colonic bladder after surgery from October 1995 to January 2003 was performed. 83 males and 22 females. Age 32 ~ 78 years old, average 60 years old. Follow-up time of 9 to 82 months, an average of 40.5 months. Results Long-term complications occurred in 27 cases (25.7%), of which catheterization was difficult in 4 cases (3.8%), 3 cases were cured after urethral dilation, and 1 case was re-operated with the terminal ileum to reconstruct the output tract. 5 cases (4.8%), 4 cases of storage allantoic stone were cured, 1 case without symptoms were not treated; storage of perforation in 1 case (0.9%), cured after surgical repair; One case (0.9%) underwent storage alveolar contraction; 8 cases (7.6%) had hydronephrosis and one case had ureteral reflux. The lower ureter stenosis was merged in 4 cases, of which 2 cases were treated by stricture ureteral resection and 1 Cases of preoperative azotemia to develop uremia need regular hemodialysis; Blood chlorine increased in 7 cases (6.7%), 1 case of high-chloride acidosis need long-term oral sodium bicarbonate; simple symptoms of urinary symptoms Infected in 1 case (0.9%). In 27 cases, 10 cases were complicated with symptoms of urinary tract infection. According to the result of urine culture, sensitive antibiotics were cured. Conclusions The long-term complication after controlled blind operation with blind ascending colon is associated with symptoms of urinary tract infection, and active prevention and control of urinary tract infection, regularity, adequate storage of bladder and timely cleaning and catheterization for the prevention of long-term complications Have an important role.