Elabbady A A, Elabbasy W I, Arafa A F, Atta M A, Abdel-Rahman M
Urology Department, Alexandria School of Medicine, Alexandria University, Egypt.
J Urol. 1998 Sep;160(3 Pt 1):714-7. doi: 10.1016/S0022-5347(01)62765-4.
A new modification for urinary diversion following cystectomy is presented.
A total of 20 patients with bladder cancer who were treated with radical cystectomy underwent urinary diversion using a new technique. The sigmoid colon is dismembered approximately 30 cm. proximal to the peritoneal reflection and detubularized by anterior incision in its proximal two-thirds. Ureters are reimplanted by nipple or submucosal tunnel technique. The rectosigmoid sheet is folded on itself and closed to form a rectosigmoid pouch. The terminal colon is reanastomosed end to side to the anterior surface of the rectum just proximal to the peritoneal reflection.
During 4 to 36 months of followup all patients had complete daytime continence and only 2 had minimal nighttime fecal incontinence. The average daytime and nighttime evacuation frequency was 6 and 2 times, respectively. All patients were able to withhold voiding for an average of 30 minutes after maximum desire to void. Eight patients voided clear urine separated from stools in most instances while 12 voided mixtures of urine and stools. Postoperative excretory urogram revealed improvement of previously dilated systems in 8 renal units, deterioration in 4 and stable renal morphology in 28. An ascending pouchogram demonstrated good filling capacity in all cases. Urodynamic studies revealed low basic pressure within the pouch (mean 9.7 +/- 1.8 cm. water) with high compliance (mean 32.3 +/- 10).
This type of diversion provides a low pressure urine reservoir with satisfactory early results of preservation of the upper urinary tract and evacuation pattern.
介绍一种膀胱切除术后尿流改道的新改良方法。
20例接受根治性膀胱切除术的膀胱癌患者采用新技术进行尿流改道。乙状结肠在距腹膜返折约30 cm处离断，在其近端三分之二处做前侧切口去管化。输尿管采用乳头或黏膜下隧道技术再植。直肠乙状结肠片自身折叠并封闭形成直肠乙状结肠袋。终末结肠在腹膜返折近端与直肠前表面端端吻合。
随访4至36个月期间，所有患者白天完全控尿，仅2例夜间有轻微粪便失禁。白天和夜间平均排便频率分别为6次和2次。所有患者在最大排尿欲望后平均能憋尿30分钟。8例患者在大多数情况下排出的尿液与粪便分离，12例排出尿液和粪便的混合物。术后排泄性尿路造影显示，8个肾单位先前扩张的系统有所改善，4个恶化，28个肾单位肾形态稳定。逆行袋状造影显示所有病例充盈良好。尿动力学研究显示，袋内基础压力低（平均9.7±1.8 cm水柱），顺应性高（平均32.3±10）。
这种改道方式提供了一个低压储尿囊，在上尿路保留和排尿模式方面早期效果令人满意。
