改良Sigma直肠膀胱术_医学论文.docVIP

改良Sigma直肠膀胱术_医学论文 改良Sigma直肠膀胱术_医学论文 作者：张 前，吴宏飞，邰云飞，翁文俊，曹奕波 【摘要】 目的 评价改良Sigma直肠膀胱术式可控性尿流改道的临床疗效。方法 在2002年1月～2004年6月对5例膀胱癌患者采用改良Sigma直肠膀胱术式。折叠乙状结肠约25cm后全层切开，再缝合成低压袋，顶端固定在骶岬处，两输尿管末端合并，从低压袋上方引入，与切除了一小片段的肠黏膜匙形吻合再植。结果 全组所有患者尿控率100%，无尿失禁、未发生明显酸碱平衡紊乱、肾功能损害及上尿路感染、上尿路结石、吻合口狭窄等并发症。结论 改良Sigma直肠膀胱术并发症低、尿控效果好，术后生活质量较高，是一种快速、安全并简单易行的尿流改道方法。 【关键词】 膀胱肿瘤；Sigma直肠膀胱术；尿流改道 The modified Sigma rectum pouch ZHANG Qian，WU Hong-fei，TAI Yun-fei，et al. Department of Urology，The Third Affiliated Hospital， Nanjing Medical University， Yangzhou 211900， China　 【Abstract】 Objective To introduce a modified technique of Sigma rectum pouch procedure as a continent urine reservoir after radical cystectomy.Methods 5 cases of bladder cancer underwent the modified Sigma rectum pouch operation from Jan.2001 to Jun.2004.A segment of sigmoid colon was folded and a longitudinal incision about 25cm was made on the sigmoid wall and the incision was sutured so as to form a low pressure pouch.The vertex of the new pouch was fixed to the sacrum.The ends of the 2 ureterers were anastomosed together and was then drawn into the top of the pouch for 2 cm and finally the ureterosigmoidostomy was accomplished.Results Continence rate was 100%.All the patients were able to distinguish between stool and urine.Symptomatic renal infection and hyperchloremic acidosis occurred seldomly.No patient developed upper tract stone or ureterointestinal anastomotic stricture.Conclusion The modified sigma rectum pouch procedure is a quick，safe and easy to perform urinary diversion which serves as a satisfying alternative for patients in terms of quality of life.Follow-up shows a low complication rate with good results in terms of continence. 【Key words】 bladder neoplasms； Sigma rectum pouch； continent uinary diversion 1993年Fisch等［1］首次采用Sigma直肠膀胱术做可控性尿流改道，国内程双管等［2］于2001年提出改良Sigma直肠膀胱术，我们将程双管等的方法再改良，自2002年1月～2004年6月对5例膀胱癌患者行膀胱全切除、改良Sigma直肠膀胱术，效果满意。现将结果报告如下。 1 资料与方法 1.1 一般资料 本组5例中，男3例，女2例；年龄40~67岁，平均年龄58.8岁。均为多发性、复