关键词：膀胱肿瘤；癌；尿流改道
摘 要 ：目的 探讨无处理阑尾脐部造口可控性回结肠膀胱术的临床效果。方法 回、结肠各约20cm，纵形剖开、拼接形成囊袋。采用未经处理的阑尾由脐部直接引出造口。共为31例膀胱肿瘤和1例间质性膀胱炎患者实施了膀胱全切、无处理阑尾经脐造口的可控性回结肠膀胱术。结果 新膀胱容量300～500ml，内压达40cmH2 O无尿溢出。患者可自我导尿，造口勿需覆盖，不影响任何活动。 随访6个月至5年，临床效果满意。结论 无处理阑尾经脐造口的可控性回结肠膀胱术，方法简便，手术时间短，阑尾造口隐蔽，控尿能力可靠，自我插管方便，无明显并发症。为尿流改道者提高了生活质量。
Unaltered appendicostomy in situ through umbilicus as a conduit for continent ileocecal urinary diversion (report of 32 cases)
QIN Wanchang
( 304 Hospital of PLA,Beijing 100037,China)
LI Jiyu
( 304 Hospital of PLA,Beijing 100037,China)
SHI Yimin,et al
( 304 Hospital of PLA,Beijing 100037,China)
Abstract ： Objective To evaluate the use of an unaltered appendicostomy in situ through umbilicus as a conduit for continent urinary diversion (UAU pouch).Methods An isolated intestinal segment consisting of 20cm of distal ileum and 20cm of ascending colon was formed as a reservoir after being opened longitudinally. The distal ends of both the ureters were anastomosed to the reservoir submucously. The unaltered appendix in situ was pulled out through the umbilical hole which just accommodated the appendix and formed a stoma.Results A total of 32 cases suffered from bladder cancer except one who suffered from serious interstitial cystitis have undergone the new operation after total cystectomy.The pouch is continent for about 300～ 500ml of urine and the intrareservior pressure could reach 40cm water without any leakage. The patient himself can insert a catheter into the stoma easily and can take part in any activities.Conclusions UAU pouch has many advantages such as time-saving, concealed stoma, good continence, easy self-catheterization, adequate blood supply,no morbidity, and widens the indications for appendicostomy and provides good quality of life for the patients.
Key words ： Bladder neoplasms Carcinoma Urinary diversion▲
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