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目的:为膀胱全切术后的患者提供更好的控尿术式。方法:回顾性分析1998～2010年间28例可控性尿流改道(可控性回结肠膀胱)和21例原位肠代膀胱的并发症发生率及其对患者生活质量的影响。可控性回结肠膀胱组前9例行Indiana术式,后19例行改良的Indiana术式。原位肠代膀胱组采用乙状结肠或“W”形回肠纵行剖开制成贮尿囊。结果:本研究组49例均获得随访,随访时间6个月～12年。可控性回结肠膀胱组28例自行清洁导尿,间隔时间90～270min,平均240min。原位肠代膀胱组21例在腹压的辅助下自行排尿,排尿间隔时间150～240min,平均195min。可控性回结肠膀胱组中22例感觉生活满意或基本满意(78.6%),6例感觉生活不便(21.4%);9例出现并发症(32.1%)。原位肠代膀胱组中19例患者感觉生活满意(90.5%),2例感觉不满意(9.5%),均为压力性尿失禁;3例出现并发症(14.3%)。结论:原位肠代膀胱患者的生活质量优于可控性回结肠膀胱,术后并发症方面,原位肠代膀胱组患者并发症明显小于可控性回结肠膀胱组。
OBJECTIVE: To provide better control of urine for patients after total mastectomy. Methods: A retrospective analysis of 28 cases of controllable urinary diversion (controllable ileocolonic bladder) and 21 cases of in situ intestinal metaplasia between 1998 and 2010 was conducted to investigate the incidence of complications and its impact on the quality of life of patients. The controllability of the colon and urinary bladder group before the Indiana operation 9, followed by 19 modified Indiana surgery. In situ intestinal metaplasia group with sigmoid colon or “W ” shaped ileum longitudinal dissection made of storage urine. Results: All 49 patients in this study group were followed up for 6 months to 12 years. Controlled back to the bladder in 28 cases of spontaneous urinary catheterization, the interval of 90 ~ 270min, an average of 240min. In situ intestinal metaplasia group, 21 cases under the pressure of abdominal self-help urination, urination interval 150 ~ 240min, an average of 195min. In the control group, 22 cases of sensory life were satisfied or basically satisfied (78.6%), 6 cases felt inconvenience of living (21.4%), and 9 cases (32.1%) had complications. Among the 19 patients who underwent enalapril, 19 (90.5%) were satisfied with life expectancy and 2 (9.5%) were not satisfied with stress urinary incontinence. Complications (14.3%) occurred in 3 patients. Conclusion: The quality of life of patients with primary intestinal metaplasia is better than controllable intraocular urinary bladder. Complications of patients with primary intestinal metaplasia were significantly less than those with controllable intraocular urinary bladder.