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目的:探讨去带可控性盲升结肠膀胱术、回肠可控膀胱术及回肠原位新膀胱术的临床疗效。方法:对 14例患者采用去带可控性盲升结肠膀胱术,8例采用回肠可控膀胱术,12例采用回肠原位新膀胱术,对3种术式的并发症、可控性、尿容量、排尿次数及间隔时间、肾功及肾积水情况进行对比分析。结果:1例回肠可控膀胱术及2 例回肠原位新膀胱术可控性差,但随容量增加及经肛门括约肌训练,溢尿逐渐消失,1例回肠原位新膀胱术患者发生漏尿,1个月后自愈。3例回肠原位新膀胱术患者发生排尿困难,经扩张后症状消失。术后半年,去带可控性盲升结肠膀胱术容量平均400 ml左右,4 h导尿1次,最大容量700-1 200 ml;回肠可控膀胱术容量300-400 ml, 2．5-4 h导尿1次,最大容量400-1 000 ml左右;回肠原位新膀胱术容量250-300 ml左右,3-4 h排尿1次,最大容量300-100 ml。结论:在严格选择适应证的基础上,应先选择回肠原位新膀胱术,有利于改善病人生活质量。其次可选择去带可控性盲升结肠膀胱术,此术式可建立低压、大容量的储尿囊。
Objective: To investigate the clinical curative effect of blind ascending colonic bladder surgery, controlled ileal bladder surgery and ileal neobladder surgery. Methods: Totally 14 patients were treated with blind ascending colonic bladder surgery, 8 with ileal controllable bladder surgery and 12 with ileal neobladder. The complications, controllability, Urine volume, voiding frequency and interval time, renal function and hydronephrosis were compared. Results: The controllability of 1 case of ileal controllable bladder surgery and 2 cases of ileal orthotopic neobladder was poor, but with the increase of capacity and training of anal sphincter, urine overflow gradually disappeared, 1 case of ileal neo-neobladder occurred leakage of urine, 1 month after healing. Three cases of ileal neobladder occurred in patients with dysuria, symptoms disappeared after expansion. Six months after operation, the capacity of the blind ascending colon bladder with controllable average 400 ml, catheterization 1 h 4 h, the maximum capacity of 700-1 200 ml; ileal controllable bladder capacity 300-400 ml, 2.5- 4 h catheterization 1, the maximum capacity of 400-1 000 ml; ileum in situ bladder capacity 250-300 ml, 3-4 h urination 1, the maximum capacity of 300-100 ml. Conclusion: On the basis of strict indications, ileal orthotopic neobladder should be selected to improve the quality of life of patients. Second, choose to go with controllable ascending colon and bladder surgery, this technique can be established low-pressure, high-capacity storage of urine.