全膀胱切除术后并发症的预防和处理VIP免费

�临床研究�全膀胱切除和原位新膀胱术并发症的预防和处理周芳坚1�余绍龙1�熊永红1�李永红1�刘卓炜1�韩辉1�秦自科1��[摘要]�目的:报告全膀胱切除+原位新膀胱术后并发症的预防和处理经验。方法:对全膀胱切除+原位新膀胱术患者的并发症和处理结果进行回顾性总结,分析手术改良措施对并发症的预防作用。结果:对全膀胱切除+原位新膀胱术进行多处改良,119例术后共发生并发症20例,其中切口全层裂开5例,再次缝合治愈;输尿管吻合口漏和狭窄各1例,经再次开放手术治愈;输尿管口粘连8例,经内镜下手术治愈;不完全性肠梗阻3例,经保守治疗得到控制;慢性代谢性酸中毒和低钾血症2例,需长期服药纠正。无膀胱输尿管返流和肾功能不全病例。结论:经改良手术技术和采取预防措施后,全膀胱切除+原位新膀胱术的并发症减少,再次手术可纠正大部分外科并发症。[关键词]�膀胱癌;尿流改道;原新膀胱;手术并发症��[中图分类号]�R737.14��[文献标识码]�A��[文章编号]�1001�1420(2008)07�0489�03PreventionandmanagementofsurgicalcomplicationsaftertotalcystectomyandneobladderZHOUFangjian1�YUShaolong1�XIONGYonghong1�LIYonghong1LIUZhuowei1�HANHui1�QINZike1(1DepartmentofUrology,CancerCenter,SunYat�SenUniversity,Guangzhou,510060,China)��Abstract�Objective:Toreportourexperienceonpreventionandmanagementofsurgicalcomplicationsaftertotalcystectomyandneobladder.Methods:Surgicalcomplicationsoccurredinpatientsaftertotalcystectomyandneobladderforinvasivebladdercancerwereanalyzedretrospectively.Theimpactofmodificationinsurgicaltech�niquesofcystectomyandneobladderonpreventionofsurgicalcomplicationswasalsoanalyzed.Results:Modifica�tionshadbeenmadeinmanyaspectsfortotalcystectomyandneobladder.Complicationsoccurredin20of119pa�tients.Thecomplicationsincludingwounddehiscencein5cases,ureteralanastomoticleakageandstenosisin1caserespectively,andconglutinationofureterorificesin8cases,werecorrectedsurgicallywithoutsequela.Threepa�tientswithileusand2patientswithmetabolicacidosisandhypokalemiaweremanagedconservativelyandsuccess�fully.Ureteralrefluxandrenalfunctionfailuredidnotdevelopinanypatient.Conclusions:AfterModifiedthecom�plicationsaftertotalcystectomyandneobladderdecreased.Surgicalcomplicationcouldbecorrectedbyre�opera�tion.Keywords�Bladdercancer;Urinarydiversion;Neobladder;Surgicalcomplication1华南肿瘤学国家重点实验室�中山大学肿瘤防治中心泌尿外科(广州,510060)[通讯作者]周芳坚(E�mail:zhoufj@mail�sysu�edu�cn)��全膀胱切除后采用改良肠道原位新膀胱术重建下尿路后可使患者恢复排尿功能,临床效果我们已作报道1!,本文报道改良全膀胱切除和原位新膀胱术有关并发症及其预防。1�资料与方法1.1�临床资料我院从2000年1月~2007年2月应用改良全膀胱切除和原位新膀胱术治疗了119例浸润性膀胱癌患者,其中男性109例,女性10例。年龄33~78岁,平均55岁。初发或初发患者77例,复发患者42例。术前活检移行细胞癌108例,鳞癌7例、腺癌3例,小细胞癌1例。按照WHO分级标准移行细胞癌III级44例、II级62例、I级2例。1.2�手术方法全膀胱切除方法:采用改良全膀胱切除方法1,2!,主要改良有:∀先在腹膜外分离膀胱前列腺两侧直达盆底筋膜,切开盆底筋膜,双重缝扎阴茎背静脉丛但不切断;之后再切开腹膜进入腹腔,分离输尿管和膀胱前列腺;#保留前列腺尖周围尿道横纹括约肌和前列腺两侧的神经血管束。原位新膀胱制作:回肠膀胱91例,乙状结肠膀胱28例。原位新膀胱制作的改良之处有:∀肠段去管道化后,用2-0吸收线连续锁边缝合成片(回肠W型,结肠U型);#先做新膀胱尿道吻合,后作输尿管吻合;新膀胱最低位边缘直接与后尿道残端采用连续缝合法吻合;∃输尿管新膀胱吻合采用半乳头直接种植法3!,吻合后利尿见吻合口喷尿良�489�临床泌尿外科杂志2008年7月第23卷第7期好,不留置支架管。1.3�随访情况出院后2...