Nechiporenko N A, Galkin L P
Urol Nefrol (Mosk). 1989 Jul-Aug(4):43-7.
Cystectomy with ureterosigmoid anastomosis by modified Goodwin's technique was performed in 47 patients with local vesical cancer. Pre- and postoperative functional status of the kidneys was assessed by means of renography, excretory urography and laboratory tests. Unilateral or bilateral renal dysfunction developed within 12 to 18 months after surgery in 22.2% of patients with good pretreatment renal status. In cases of preoperative renal impairment, it improved postoperatively in just 35% of the patients. Rectoromanoscopy, contrast sigmoidography and excretory urography demonstrated pathological conditions in the area of ureterointestinal anastomoses (strictures, gaping or anastomositis) or sigmoid changes (sigmoiditis, kinking or stenosis in the perianastomosis area) in 83.3% of patients with impaired postoperative renal function. These conditions lead to hydroureteronephrosis, intestinoureteral refluxes and progress or development of pyelonephritis as a result. It is concluded that the state of ureterointestinal anastomoses and the sigmoid should be assessed specifically in postureterosigmoid anastomosis patients with impaired renal function. The surgical techniques and the degree of ureteral dilatation can make an important contribution to pathologic conditions developing around the anastomoses. Good functional activity of the kidneys and the absence of upper urinary dilatation are the principal prerequisite for ureterosigmoid anastomosis.
采用改良古德温技术行膀胱切除术并输尿管乙状结肠吻合术治疗47例局限性膀胱癌患者。通过肾图、排泄性尿路造影和实验室检查评估术前和术后肾脏的功能状态。术前肾功能良好的患者中，22.2%在术后12至18个月内出现单侧或双侧肾功能障碍。术前存在肾功能损害的患者中，术后仅有35%的患者肾功能得到改善。直肠乙状结肠镜检查、乙状结肠造影和排泄性尿路造影显示，术后肾功能受损的患者中83.3%在输尿管肠吻合口区域（狭窄、裂开或吻合口炎）或乙状结肠出现病理状况（乙状结肠炎、扭结或吻合口周围狭窄）。这些状况导致输尿管肾盂积水、肠输尿管反流，并进而导致肾盂肾炎的进展或发生。得出的结论是，对于肾功能受损的输尿管乙状结肠吻合术患者，应特别评估输尿管肠吻合口和乙状结肠的状况。手术技术和输尿管扩张程度对吻合口周围病理状况的发生有重要影响。肾脏良好的功能活动和上尿路无扩张是输尿管乙状结肠吻合术的主要前提条件。
