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1、临床泌尿外科杂志2008年7月第23卷第7期489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1111111周芳坚余绍龙熊永红李永红刘卓炜韩辉秦自科[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
2、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]10011420(2008)07048903Preventionandmanagementofsurgica
3、lcomplicationsaftertotalcystectomyandneobladder1111ZHOUFangjianYUShaolongXIONGYonghongLIYonghong111LIUZhuoweiHANHuiQINZike1(DepartmentofUrology,CancerCenter,SunYatSenUniversity,Guangzhou,510060,China)AbstractObjective:Toreportourexperienceonpreve
4、ntionandmanagementofsurgicalcomplicationsaftertotalcystectomyandneobladder.Methods:Surgicalcomplicationsoccurredinpatientsaftertotalcystectomyandneobladderforinvasivebladdercancerwereanalyzedretrospectively.Theimpactofmodificationinsurgicaltechniquesofcy
5、stectomyandneobladderonpreventionofsurgicalcomplicationswasalsoanalyzed.Results:Modificationshadbeenmadeinmanyaspectsfortotalcystectomyandneobladder.Complicationsoccurredin20of119patients.Thecomplicationsincludingwounddehiscencein5cases,ureteralanastomo
6、ticleakageandstenosisin1caserespectively,andconglutinationofureterorificesin8cases,werecorrectedsurgicallywithoutsequela.Threepatientswithileusand2patientswithmetabolicacidosisandhypokalemiaweremanagedconservativelyandsuccessfully.Ureteralrefluxandrenal
7、functionfailuredidnotdevelopinanypatient.Conclusions:AfterModifiedthecomplicationsaftertotalcystectomyandneobladderdecreased.Surgicalcomplicationcouldbecorrectedbyreoperation.KeywordsBladdercancer;Urinarydiversion;Neobladder;Surgicalcomplication全膀胱切
8、除后采用改良肠道原位新膀胱术重标准移行细胞癌III级44例、II级62例、I级2例。建下尿路后可使患者恢复排尿功能,临床效果我们1.2手术方法1!已作报道,本文报道改良全膀胱切除和原位新膀全膀胱切除方法:采用改良全膀胱切除方1,2!胱术有关并发症及其预防。法,主要改良有:∀先在腹膜外分离膀胱前列腺1资料与方法两侧直达盆底筋膜,切开盆底筋膜,双重缝扎阴茎1.1临床资料背静脉丛但不切断;之后再切开腹膜进入腹腔,分我院从200
