经脐阑尾输出道可控膀胱术 附2例报告

叶晶　孙元星　张慧文　刘玉军

　　摘要：目的：报告2例膀胱癌患者利用盲肠、阑尾组合行下尿路改道重建术。方法：利用阑尾盲肠组合行下尿路改道重建术，新膀胱分别由盲肠及回盲肠制成，阑尾作为输出道，术中通过将阑尾基部缝合至盲肠壁内来加强新膀胱括约肌的功能，并且阑尾输出道经脐引出。结果：术后3～6个月，其膀胱容量分别增至380mL、400mL，膀胱内压分别为25cmH2O、30cmH2O，随访中无尿液返流及肾积水，但一个患者术后患肾盂肾炎。临床证实，该尿流改道术效果佳。结论：临床上阑尾盲肠组合可应用于下尿路重建术，并且阑尾、盲肠交界处功能可在术后测试，术中新膀胱括约肌功能的加强是必要的，该术式术后经阑尾腔内插管容易，且输出道经脐引出方便，术后外观隐蔽美观。
　　关键词：膀胱癌；尿流改道；阑尾
　　中图分类号：R737.14　　文献标识码：B
文章编号：1006－8716(2000)02－0127－03

Contient urinary reservoirs with the ceco-appendiceal unit as stoma to umbilicus

YE Jing，SUN Yuan-xing
(The Fifth People Hospital of Datong，Datong 037001，of Datong，Datong 037006，China)
ZHANG Hui-weng
(The Second Medical School of Datong，Datong 037005，China)
LUI Yu-jun
(The South Suburbam People Hospital of Datong，Datong 037006，China)

　　Abstract：Objective：We report short-term results in 2 patients with bladder cancer who underwent lower urinary tract reconstruction using a ceco-appendiceal unit.Methods：A man and a women underwent lower urinary tract reconstruction using an altered cecoappendical unit.The bladder was replaced with a reserroir of ileocolic. cecocolic and the appendix was used as an orthotopic neouretha， and the cecoappendiceal junction was incompeted the cecum， the cecum was plicated over the base of the appendix to reinforce the sphincteric mechanism.This two patients underwent augmentation with the appendix brought out as a umbilical stoma.Result：The patients have been followed up for 3-6months.The separate capacity of the urine reservoir has been 380ml、400ml.The separate intrareservoir pressllre 25cmH2O、30cmH2O.There has been neither urine reflux nor hydronephrosis.One patient suffer from pyelonephritis.Continence of unurination has been excellent.Conclusions：The ceco-appendiceal unit may be used for continent lower urinary tract reconstruction. Ceco-appendiceal junction competence can be tested intraoperatirely and skincteric mechanism may be reinfored as nessary

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