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目的探讨胃代膀胱术的远期疗效。方法对1991年5月至2003年10月30例胃代膀胱术患者的临床资料进行统计分析。其中膀胱肿瘤28例,结核性膀胱挛缩2例。结果随访8～13年,平均10年。30例全身健康情况良好,日间排尿满意,3例偶有夜间尿失禁。1例术后19个月发生代膀胱穿孔,经抗酸和手术治疗痊愈。30例肾功能正常,无电解质紊乱;24例排尿前后胃泌素及尿液pH检查正常;4例有无症状菌尿。13例代膀胱黏膜活检为慢性炎症,壁细胞减少;9例免疫组化检查G细胞较正常减少。尿动力学检查代膀胱容量及顺应性正常,排尿期贮尿囊压力低于正常。10例行排尿期膀胱造影无输尿管返流,5例B超示肾集合系统轻度扩张。1例低压胃膀胱成形术,1例胃与后尿道逆蠕动吻合,剩余尿分别为150ml和250ml。1例出现血尿尿痛综合征,经抗酸及碱化尿液治疗后缓解。结论胃代膀胱术远期疗效满意,是一种较好的尿流改道方法。
Objective To investigate the long-term effect of gastric bypass on bladder surgery. Methods The clinical data of 30 patients with gastroesophageal varices from May 1991 to October 2003 were analyzed statistically. Including 28 cases of bladder cancer, tuberculous bladder contracture in 2 cases. The results were followed up for 8 to 13 years, an average of 10 years. 30 cases of good general health, satisfied with urination during the day, 3 cases of occasional urinary incontinence at night. One case occurred 19 months after the generation of bladder perforation, by acid and surgery cured. 30 cases of normal renal function, no electrolyte imbalance; 24 cases of urinary excretion before and after gastrin and urine pH normal; 4 cases of asymptomatic bacteriuria. 13 cases of bladder biopsy on behalf of the chronic inflammation, parietal cells decreased; 9 cases of immunohistochemical G cells decreased compared with normal. Urodynamic examination on behalf of the normal bladder capacity and compliance, urinary storage urinary bladder pressure is lower than normal. Ten patients underwent urinary bladder cystography without ureteral reflux, and 5 patients underwent B-mode renal enlargement. 1 case of low-pressure stomach cystoplasty, 1 case of retrograde anastomosis of the posterior urethra with residual urine of 150ml and 250ml, respectively. 1 case of hematuria and pain syndrome, anti-acid and alkalized urine after remission. Conclusion Gastroesophageal approach is satisfactory in long-term efficacy and is a good urinary diversion method.