CAJ | 학술논문

目的评价乙状结肠直肠储尿囊压力-容积变化及尿流率和上尿路功能. 方法 2007-2011年,行根治性膀胱切除术并乙状结肠直肠储尿囊术(Mainz pouch Ⅱ)治疗肌层浸润性膀胱癌患者10例.输尿管植入≥30 cm去管化乙状结肠后壁.术前行结肠镜检查并测定肛门括约肌张力,术后3～6个月行影像尿动力学检查和尿流率测定,IVU检查评价上尿路功能. 结果乙状结肠直肠储尿囊平均容量360 m1(270 ～ 532 ml)时未产生反流.术后3～6个月,乙状结肠直肠压力平均为26 cm H2O,肛门括约肌张力维持90 cm H2O.上尿路及肾功能保护良好.腹压排尿方式下平均Qmax为30 ml/s,平均尿流率为8 ml/s.术后最初2个月内有轻度尿失禁,第3个月开始逐渐达到控尿,夜尿次数1～4次.发生代谢性酸中毒1例,口服碳酸氢钠片及氯化钾缓释片后治愈. 结论乙状结肠直肠储尿囊能够达到高容、低压,且无上尿路及降结肠反流；代谢性酸中毒发生率低；是一种能够保证良好上尿路功能和高生活质量的尿流改道方法.
목적 평개을상결장직장저뇨낭압력-용적변화급뇨류솔화상뇨로공능. 방법 2007-2011년,행근치성방광절제술병을상결장직장저뇨낭술(Mainz pouch Ⅱ)치료기층침윤성방광암환자10례.수뇨관식입≥30 cm거관화을상결장후벽.술전행결장경검사병측정항문괄약기장력,술후3～6개월행영상뇨동역학검사화뇨류솔측정,IVU검사평개상뇨로공능. 결과 을상결장직장저뇨낭평균용량360 m1(270 ～ 532 ml)시미산생반류.술후3～6개월,을상결장직장압력평균위26 cm H2O,항문괄약기장력유지90 cm H2O.상뇨로급신공능보호량호.복압배뇨방식하평균Qmax위30 ml/s,평균뇨류솔위8 ml/s.술후최초2개월내유경도뇨실금,제3개월개시축점체도공뇨,야뇨차수1～4차.발생대사성산중독1례,구복탄산경납편급록화갑완석편후치유. 결론 을상결장직장저뇨낭능구체도고용、저압,차무상뇨로급강결장반류；대사성산중독발생솔저；시일충능구보증량호상뇨로공능화고생활질량적뇨류개도방법.
Objective To measure the pressure-volume changes and uroflow rate,and assess the function of upper urinary tract in sigmoidorcctal pouch patients.Methods Between 2007 and 2011,a to-tal of 10 patients who had a radical cystectomy because of muscle-invasive bladder tumor underwent a Mainz pouch Ⅱ procedure were evaluated.The ureters were implanted into the post walls of the detubularized sigmoid segment at least 30 cm in length.In all cases,sigmoidoscopy was done and the anal pressure was measured preoperatively,and video urodynamic study of sigmoidorectal pouch as well as the intravenous pyelography was conducted after 3 to 6 months postoperatively.Results Video urodynamic study of sigmoidorectal pouch revealed that no reflux up to an average volume of 360 ml (270-532 ml) of the descending colon.The sigmoidal colon pressure was 26 cm H2O during the 3 to 6 months post-operative follow-up.The anal sphincter pressure was 90 cm H2O on average preoperatively and did not change postoperatively.The renal function and upper urinary tract were preserved well.The Qmax was 30 ml/s and the average uroflow rate was 8 ml/s under abdominal strain.All the patients suffered slight incontinence in the first two months and became continent since the 3 month postoperatively with nocturnal voiding one to four times.Conclusions The sigmoidorectal pouch provides a reservoir with a higher capacity,lower pressure without reflux to the upper urinary tract and descending colon and lower metabolic acidosis problem.It is also a good alternative diversion procedure that would preserve upper urinary tract and good quality of life.