论文部分内容阅读
目的 研究楔形胃代膀胱术的适应证、效果及并发症。 方法 1992年5月至2003年12月,选择膀胱癌全膀胱切除术的病例,行楔形胃代膀胱术61例,均经尿道排尿。术后随访排尿情况、实验室检查、尿动力学检查、影像学检查、膀胱镜检及了解并发症等。 结果 61例术后随访5个月~12年,平均6年。排尿通畅者占70. 49% (43 /61);排尿间隔2~4. 5h,平均3h;尿量280~520ml,平均385ml;最大尿流率13~25ml/s,平均17ml/s;膀胱容量300~550ml,平均375ml;最大尿道压20~60cmH2O,平均48cmH2O;充盈期膀胱压5~14cmH2O,平均11cmH2O;最大膀胱压40~65cmH2O,平均55cmH2O;排尿期最大膀胱压25~60cmH2O,平均45cmH2O。尿道吻合口狭窄者9. 84% (6 /61),电切后被纠正。膀胱颈切除术后尿失禁者为100% ( 12 /12 ),占总病例的19. 67%(12 /61),术后3~6个月尿失禁渐缓解。尿道灼痛伴尿道口溃疡者9. 84% ( 6 /61 ),均为尿失禁者。无不稳定性膀胱。遗尿者32. 65% ( 16 /49 )。左输尿管原位与胃膀胱吻合致左肾输尿管积水者为100% (9 /9),左输尿管经骶前腹膜后移至右侧与胃膀胱吻合者无此现象。剩余尿量(1~125ml,平均30ml)81. 63% (40 /49)。尿潴留者2例。尿路感染者5例,均为排尿不畅者。血尿尿痛症者16. 39%(10 /61)。酸性尿者100% (61 /61),尿pH 4. 5
Objective To study the indications, effects and complications of wedge-shaped stomach-to-bladder surgery. Methods From May 1992 to December 2003, patients undergoing total cystectomy for bladder cancer were selected. Sixty-one patients underwent wedge-shaped gastric bypass and bladder allograft urination. Postoperative urination, laboratory tests, urodynamic examination, imaging examination, cystoscopy and understand the complications. Results 61 cases were followed up for 5 months to 12 years, an average of 6 years. Urine volume was 280-520ml with an average of 385ml; the maximal uroflow rate was 13-25ml / s with an average of 17ml / s; urinary bladder The maximum bladder pressure 40 ~ 65cmH2O, an average of 55cmH2O; voiding urinary maximum bladder pressure 25 ~ 60cmH2O, an average of 45cmH2O; bladder pressure at filling of 5 ~ 14cmH2O, an average of 11cmH2O; . Urethra anastomotic stenosis was 9.44% (6/61), after cutting was corrected. Urinary incontinence after bladder neck resection was 100% (12/12), accounting for 19.67% (12/61) of the total cases, urinary incontinence gradually relieved 3 to 6 months after operation. Urethral burning with urethral ulcer 9. 84% (6/61), are incontinence. No instability of the bladder. Enuresis 32.65% (16/49). Left anterior urethral anastomosis of the stomach and the left ureter caused by hydronephrosis were 100% (9/9), left ureter retroperitoneal metastasis to the right and stomach anastomosis without this phenomenon. Remaining urine output (1 ~ 125ml, average 30ml) 81. 63% (40/49). Urinary retention in 2 cases. Urinary tract infection in 5 cases, are poor urination. Hematuria and dysuria were 16.39% (10/61). Aciduria were 100% (61/61), urine pH 4.5