可控膀胱增强缩窄回肠控制机制的尿动力学研究
Urodynamic study of enhanced continent mechanism using tapered ileum as continent urinary reservoir
目的探讨贮尿囊与腹壁的壁外支持对增强缩窄回肠控尿能力的作用.方法 24例尿流改道的病人采用缩窄的回肠作为输出管,并将部分输出管固定在回肠贮尿囊与腹壁之间,输出管的内口与回肠贮尿囊作端侧吻合,其外口与脐孔作端端防狭窄吻合的手术方法治疗.术后1.5-3个月和6-24个月分别对输出管和贮尿囊作尿动力学检查.结果 1例术后55天死于心脏疾病,余23例中22例术后昼夜能控制尿.术后1.5-3个月尿动力学检查示贮尿囊充盈时输出管最大闭合压为46±124 cmH2O(91.26±15.71 cmH2O),空虚时34-84 cmH2O(67±10.60 cmH2O),两者间差异有显著意义(t=-11.78, P<0.0001); 6-24个月18例行尿动力学检查,贮尿囊充盈时输出管最大闭合压为80-194 cmH2O (98.89±26.34 cmH2O),空虚时为64-128 cmH2O ( 74.78±14.54 cmH2O),两者差异有显著性意义(t=-7.58, P<0.0001).贮尿囊容量为420-750 ml (481.67±78.83 cmH2O); 贮尿囊注入50 ml生理盐水时内压为6-9 cmH2O (7.17±1.17 cmH2O);贮尿囊充盈时内压为16-35 cmH2O (24.12±5.61 cmH2O),充盈过程中没有收缩波出现.结论此研究提示贮尿囊与腹壁的壁外支持可明显增强缩窄回肠的控尿能力.
更多Objective To investigate the effect of extramural support from the pouch and abdominal wall to enhance the continent mechanism of tapered ileum. Methods A total of 24 patients underwent a procedure in which an ileal segment was tapered into an efferent tube, of which a part was placed between the back surface of the rectus muscle and the ileal pouch wall. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice was anastomosed to the umbilicus. A urodynamic study of the efferent tubes and pouch was done 1.5 to 3 months and 6 to 24 months postoperatively. Results One patient died of heart disease 55 days postoperatively, while 22 of the remaining 23 were completely continent day and night. At 1.5 to 3 months, the urodynamic study of the efferent tubes demonstrated that the maximum closure pressure with a full pouch was 46-124 cmH20 (91.26±15.71 cmH20)and with an empty pouch was 34-84 cmH20 (67±10.60 cmH20). The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t=-11.78 and P=0.00001). At 6 to 24 months, a second urodynamic study was performed on 18 cases, demonstrating a reservoir capacity of 420 to 750 ml (481.67±78.83 ml). Reservoir pressure was 6 to 9 cmH2O (7.17±1.17 cmH20) when the pouch was filled to 50 ml, and 16 to 35 cmH2O (24.12±5.61 cmH20) when it was filled to maximum capacity. There was no contractive wave during the filling in any patient. Maximum closure pressure in the efferent tube was 80 to 194 cm H2O (98.89±26.34 cmH20) when the pouch was filled with saline, and 64 to 128 cmH2O (74.78±14.54 cmH20) when the pouch was empty. The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t=-7.58 and P=0.00003). Conclusions This study indicates that the continent mechanism of tapered ileum may be greatly enhanced by extramural support from the abdominal and pouch walls.
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