改良VIP回肠代膀胱术（附12例报告）

为更好地解决膀胱癌患者膀胱全切除术后的贮尿和控尿问题，采用改良ＶＩＰ回肠代膀胱术治疗１２例膀胱癌患者。其方法为截取末段回肠４０ｃｍ进行除管和回肠双重折叠作为贮尿囊，输尿管与回肠行ＬｅＤｕｃＣａｍｅｙ吻合术，回肠与后尿道端端吻合建立尿流输出道。随访６～２８个月，平均１１个月。结果：１０例白天完全控尿，２例增加腹压时有尿失禁；９例晚间完全控尿，２例部分尿失禁，１例完全尿失禁。代膀胱内压低，容量大（平均４００ｍｌ）；无输尿管返流和剩余尿。     

经尿道前列腺电汽化术治疗前列腺增生症

应用经尿道前列腺电汽化术（ＴＶＰ）治疗良性前列腺增生症１２０例。手术时间平均５０分钟，出血量平均３０ｍｌ，术后不需要膀胱持续冲洗。留置导尿管时间平均２６．５小时，拔管后病人排尿通畅。前列腺症状评分从术前２０．９降至术后３个月的５．１，最大尿流率从术前１０．６ｍｌ／ｓ增加至术后３个月的１９．２ｍｌ／ｓ。ＴＶＰ具有疗效显著，并发症少、技术简单易掌握，价格较低和住院时间短等优点。     

回肠新膀胱术的临床疗效观察

为客观地评价回肠新膀胱术的远期疗效，对５２例术后病人的可控性、尿动力学、肾功能、贮尿囊组织学变化及尿ｓＩｇＡ等进行随访研究。４９例获随访３～６６个月，平均随访３５个月。日间可控率为９４％，夜间为８１％。平均最大膀胱容积为４２４．５ｍｌ，最大内压为２．７０ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），平均剩余尿２４．８ｍｌ，最大尿流率为１８．０ｍｌ／ｓ。ＩＶＵ示８例１１条输尿管轻中度扩张，膀胱造影２例轻度返流，血肌酐、尿素氮保持正常，尿ＮＡＧ２例升高。术后病人尿ｓＩｇＡ较高。随术后时间延长，贮尿囊绒毛及微绒毛逐渐萎缩，酸中毒发生率下降，尿内粘液减少。肿瘤尿道复发１例。认为回肠新膀胱术是一种可选择的手术。     

经尿道汽化切割治疗重度前列腺增生症

目的探讨汽化切割治疗重度前列腺增生症（ＢＰＨ）的效果。方法应用汽化切割圈对４５例重度ＢＰＨ行经尿道前列腺汽化切割。前列腺重量平均７０．６ｇ,平均手术时间７５分钟,出血量平均４０ｍｌ。术后不需膀胱持续冲洗,平均留置导尿管时间４０．７小时,术后平均住院４．５天。结果最大尿流率由术前的７．２ｍｌ／ｓ上升至术后３个月的２０．３ｍｌ／ｓ,前列腺症状评分术前为２３．４,术后３个月降至５．６（Ｐ＜０．００１）。结论经尿道前列腺汽化切割出血少,手术安全且治疗效果确切,是重度ＢＰＨ的有效治疗方法     

回肠代膀胱术后尿sIgA检测的临床意义

肠代膀胱术后梗阻，返流和感染是肾功能损害的主要原因。文献报告回肠新膀胱术后梗阻和返流率较低［１］，但尿培养阳性率高达３６％［２］，却很少发生尿路感染引起的肾功能损害。因此，我们对回肠代膀胱术后可能存在的抗上尿路感染机制作了初步探讨。资料和方法　１９９１年６月至１９９７年３月，我科共行回肠新膀胱术５２例。选择其中２０例作为回肠新膀胱术后组，平均年龄５４（４～７０）岁，平均术后时间２４（６～５４）个月。另设２０例正常对照组。两组患者均用免疫散射比浊法测定尿ｓＩｇＡ及血ＩｇＡ含量。收集受检者晨尿５ｍｌ…     

不同术式可控膀胱的尿动力学分析

自１９９２年以来，对三种术式２９例可控膀胱术后１、３及６个月分别行尿动力学检查，结果表明三种术式术后６个月均能达到高容、低压，可控、无输尿管返流。平均充盈容量＞４７０ｍｌ，平均充盈囊内压＜１．９７ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），且术后随着时间的延长和增加容量训练，贮尿囊容量逐渐增大、囊内压逐渐降低。此外，术后尿动力学监控对明确溢尿原因和输尿管返流有重要意义。     

超声导向经皮穿刺膀胱颈悬吊术治疗女性压力性尿失禁（附1 …

目的 探讨超声导向经皮穿刺膀胱颈悬吊术治疗女性尿失禁的稞效果。方法 采用超声导向经皮穿刺膀胱颈悬吊术治疗女性压力性尿失标２例，术中超声监视下恢复尿道膀胱后角成９０℃。结果 １２例随访６～４８个月，平均２０．５个月，１１例无尿失禁及排尿困难，１例尿失禁复发。结论 超声导向经皮穿刺膀胱颈悬吊术治疗女性压一尿失禁简便、安全、有效。     

楔形胃代膀胱术的研究

目的研究楔形胃代膀胱术的适应证、效果及并发症。方法1992年5月至2003年12月，选择膀胱癌全膀胱切除术的病例，行楔形胃代膀胱术6l例，均经尿道排尿。术后随访排尿情况、实验室检查、尿动力学检查、影像学检查、膀胱镜检及了解并发症等。结果61例术后随访5个月～12年，平均6年。排尿通畅者占70．49％(43／61)；排尿间隔2～4．5h，平均3h；尿量280～520ml，平均385ml；最大尿流率13～25ml／s，平均17ml／s；膀胱容量300～550ml，平均375ml；最大尿道压20～60cmH2O，平均48cmH2O；充盈期膀胱压5～14cmH2O，平均11cmH2O；最大膀胱压40～65cmH2O，平均55cmH2O；排尿期最大膀胱压25～60cmH2O，平均45cmH2O。尿道吻合口狭窄者9．84％(6／61)，电切后被纠正。膀胱颈切除术后尿失禁者为100％(12／12)，占总病例的19．67％(12／61)，术后3～6个月尿失禁渐缓解。尿道灼痛伴尿道口溃疡者9．84％(6／61)，均为尿失禁者。无不稳定性膀胱。遗尿者32．65％(16／49)。左输尿管原位与胃膀胱吻合致左肾输尿管积水者为100％(9／9)，左输尿管经骶前腹膜后移至右侧与胃膀胱吻合者无此现象。剩余尿量(1～125ml，平均30ml)81．63％(40／49)。尿潴留者2例。尿路感染者5例，均为排尿不畅者。血尿尿痛症者16．39％(10／61)。酸性尿者100％(61／61)，尿pH4．5～7．0。附睾炎者1例。无幽门括约肌痉挛。术后第12个月发生膀胱颈吻合口肿瘤1例，作肿瘤切除术。术后1～5年内死于肿瘤转移者9例。术后膀胱镜检均见胃膀胱黏膜光滑平整，色泽稍苍白，未见溃疡，1年以上15例取胃膀胱黏膜作光镜及电镜观察。仅见胃膀胱黏膜间质内酸性细胞及淋巴细胞浸润。61例术后血电解质及动脉血气分析均未见明显异常，BUN及Cr值均在正常范围内。结论楔形胃代膀胱术效果好，并发症少。膀胱癌行全膀胱切除，不能保留尿道括约肌者．不宜采用经尿道排尿的原位胃膀胱术。     

乙状结肠直肠膀胱术

膀胱全切术后采用乙状结肠直肠膀胱术（ＭａｉｎｚＰｏｕｃｈＩＩ）作为可控性尿流改道。该术式以乙状结肠直肠交界为中点将肠管纵行剖开２０～２４ｃｍ，做乙状结肠直肠侧侧吻合形成大容量低压贮尿囊，输尿管采用粘膜下隧道方式做抗逆流吻合，利用肛门括约肌控制排尿。本组１１例，平均随访１０．５个月。肠代膀胱容量平均５５３ｍｌ，基础压力平均１．４７ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），最大充盈压力平均２．１６ｋＰａ。在肠袋充盈过程中顺应性良好。拔除肛管１周～２个月后可获得满意的尿便分流，２个月后排尿次数稳定，白天４～５次，夜间０～３次。无夜间尿失禁，无逆行感染及高氯性酸中毒。１例出现双侧输尿管梗阻。该术式满足了可控膀胱的基本条件，易于被患者接受，术后生活质量较高     

继发于后尿道瓣膜的膀胱输尿管返流

报告９例因排尿困难、反复泌尿系感染等症状，经排尿性膀胱尿道造影（ＭＣＵ）检查发现有后尿道瓣膜（ＰＵＶ）及继发性膀胱输尿管返流（ＶＵＲ）患儿，共１５侧。２例经后尿道切开电灼尿道瓣膜，术后留置尿管分别治疗２５和２８个月，现排尿通畅；７例经尿道内窥镜电灼尿道瓣膜，术后排尿均明显改善。术后１３～２８个月（平均１８个月），８例经ＭＣＵ复查，发现只有３侧较轻的返流消失、２侧减轻。认为继发于后尿道瓣膜的膀胱输尿管返流在瓣膜切除后返流仍难自愈，建议在瓣膜切除后尽早做抗返流处理。     

输尿管镜下尿道置管治疗尿道球部断裂疗效观察（附13例报告）

目的：探讨输尿管镜下尿道置管术治疗尿道球部断裂的方法与安全性。方法：回顾性分析应用输尿管镜下尿道置管术治疗前尿道断裂患者13例的临床资料。结果：拔管后正常排尿11例,一次性手术治愈占84．61％,最大尿流率（MFR）为（14．7±3．2）ml／S,平均手术时间为（17．7±3．2）min;术后尿道出血2例,占15：38％;6个月年后因尿道狭窄行开放手术1例,占7．69％。结论：在有效地控制治疗适应证的前提下,输尿管镜下尿道置管术治疗尿道球部断裂是安全、有效的方法。     

Does urethral instrumentation affect uroflowmetry measurements?

Uroflowmetry was performed before and after urethral catheterisation in 129 patients. Uroflowmetry measurements were significantly modified by urethral instrumentation. In males, both maximum and mean flow rates decreased following urethral catheterisation, while in females only the maximum flow rate decreased, the mean flow rate remaining unchanged. Voided volume increased (and consequently residual urine decreased) in females after catheterisation, but did not change significantly in males. False positive results were encountered in 32% of patients and false negative results in 11% when flowmetry was done immediately after catheterisation. Uroflowmetry after urethral instrumentation is not recommended.     

Comparative study between the use of a treatment with hyperthermia through the rectal approach versus the urethral approach for benign prostatic hyperplasia.

200 patients suffering from benign prostatic hyperplasia were treated with hyperthermia: 100 cases through the rectal approach and 100 through the urethral approach. Subjective symptoms were assessed as well as nycturia and objective data, urinary flow and postmicturition residue before treatment and 6 months after treatment. In the group of 100 patients treated rectally, the subjective symptoms and nycturia improved in 76; urine flow improved in 63, postmicturition residue decreased in 32 and the vesical catheter could be removed in 5 out of 8 patients. With the urethral approach, 77 patients out of 100 presented an improvement in their symptoms, nycturia improved in 53; urine flow improved in 28; the urine residue was decreased in 40 and the vesical catheter could be removed in 10 out of 16 patients who required it previously. Although slightly better results seem to be achieved with the use of rectal hyperthermia, as concerns nycturia and micturition flow, we prefer the urethral approach for its higher degree of convenience, easier handling, shorter time of treatment and reasonable effectiveness.     

尿道会师导引装置在尿道狭窄与闭锁的腔内手术中的应用：附视频

目的 探索在治疗尿道狭窄与闭锁的腔内手术中应用尿道会师导引装置的可行性和安全性.方法 深圳市第八人民医院自2008年1月至2012年8月,对25例后尿道狭窄和闭锁患者行腔内切开手术,其中11例应用尿道会师导引杆置入后尿道指引金属导丝穿刺通过瘢痕尿道,在导丝引导下行尿道腔内狭窄切开和瘢痕切除术,术后留置导尿管3～6周,拔管后行定期尿道扩张,现对其临床资料行回顾性分析.结果 25例腔内手术均一次成功,无中转开放手术.手术时间35～86 min,术中出血量5～25ml.20例拔尿管后排尿正常,5例排尿不畅,拔管后扩张尿道4～12次后排尿正常,出院1个月后复查尿流率,最大尿流率（Qmax）为（16.0±3.5） ml/s.术后无一例尿失禁.结论 将尿道会师导引装置应用于治疗尿道闭锁和狭窄的腔内手术中有利于引导金属导丝跨越尿道瘢痕,操作安全可靠,简便易行.     

Urethral closure function in women with prolapse

In 19 patients with different types of severe descensus, all without clinical evidence of stress incontinence, urethral stress pressure profiles and stress tests were done before and after repositioning of the prolapse. In 13 of the 19 patients, continence was artificial, because during repositioning they showed leakage of urine; however, 6 of the patients remained continent. The pressure transmission ratios decreased in different parts of the urethra in all the patients when repositioning with a gynecological speculum was done. The drop was most significant in those patients who lost urine after repositioning, showing poor urethral function. In women with genito-urinary prolapse, a test of urethral function is essential, even if there is no clinical evidence of incontinence after removal of the descensus. In cases of severe stress incontinence under this condition, a procedure for bladder neck stabilization should be added to routine prolapse surgery.     

经尿道等离子体治疗尿道狭窄与闭锁的47例临床体会

目的探讨等离子体治疗尿道狭窄与闭锁的效果。方法采用经尿道等离子体汽化切割尿道狭窄和闭锁47例,术前严格测量狭窄段的尿道长度,选择狭窄长度0.2～2.0 cm。按狭窄段长短分为2组,A组31例,狭窄段≤1 cm;B组16例,狭窄段1.1～2.0 cm。随访时间6～36个月。结果 47例患者均1次手术成功。A组31例中,排尿良好,尿流率为15～24 mL/s 27例,占87.1%,失败4例,2次腔内治疗效果不佳,后开放手术。B组16例中,排尿良好,尿流率为14.2～24 mL/s 4例,占25%,失败12例,均开放手术。术后附睾炎3例,阴茎、阴囊水肿1例。结论经尿道等离子体汽化切割治疗尿道狭窄与闭锁,出血少,手术视野清,疗效肯定,但应严格掌握手术适应证,以狭窄段≤1 cm为宜。     

Urethrorectal fistula. Report of 11 cases]

The authors report a series of 11 urethrorectal fistulas observed over a 25-year period. The mean age of the patients was 37 years (range: 15 to 70 years). The aetiologies were surgical trauma (5 cases), fracture of the pelvis (2 cases), inflammatory lesions (3 cases), and one fistula was congenital. The clinical features were dominated by urine discharge from the anus (11 cases), urinary tract infection (8 cases), spurious diarrhoea (6 cases), faecaluria (4 cases), pneumaturia (2 cases). Digital rectal examination was normal in 7 patients. IVU demonstrated opacification of the rectum in 5 out of 8 cases. Cystourethrography, performed in 9 patients, demonstrated the communication in each case. Urethrocystoscopy visualized the fistula in each case in which it was performed. Treatment consisted of bladder drainage by urethral catheter in all patients, allowing closure of the fistula in 2 patients. Colostomy was performed in 2 patients, internal urethrotomy and urethral catheter was performed in 2 cases. Surgical closure of the fistula was performed in 7 patients, via an abdominoperineal (3 cases), perineal (2 cases), transperitoneal (1 case) or transanosphincteric incision (1 case).     

综合手术治疗逼尿肌无反射性神经原性膀胱(附10例报告)

本组报告10例,采用经尿道内括约肌切断术和腹直肌转位术的综合手术治疗尿道内括约肌痉挛型的逼尿肌无反射性神经原性膀胱。手术特点:能解除膀胱出口梗阻,改善膀胱逼尿肌的功能障碍。术后病人能自行排尿,术前反复发作急性尿路感染术后均得到控制,术后血肌酐、尿素氮正常者9例,术后残余尿量均小于50ml,最大尿流率15～20ml/s,最大尿道闭合压较术前平均下降7.42kPa,功能性尿道长度较术前平均缩短2cm。     

输尿管镜下尿道置管会师术治疗尿道断裂八例

目的探讨输尿管镜下行尿道置管会师术治疗尿道断裂的临床效果和使用价值。方法对2008年10月至2011年2月间经输尿管镜下行尿道置管会师术治疗尿道断裂的病例进行回顾性分析;输尿管镜下经尿道外或内口置入导丝至膀胱,再经导丝引导插入Foley导尿管牵引固定,引流尿液2～4周后拔管。结果 8例全部手术成功,7例经尿道外口置管,另1例经尿道内、外口双向置管。前尿道不完全断裂2例,后尿道完全断裂6例。手术时间10～45min。术后随访6～12个月,6例排尿通畅,2例因尿线变细疑有尿道瘢痕狭窄定期行尿道扩张后痊愈,无尿瘘、假道、尿失禁和明显性功能障碍。结论输尿管镜下尿道置管会师术操作简单、手术时间短、对患者创伤小、术后恢复快、效果确切、并发症少。可同时解除尿潴留并恢复尿道连续性,适合各种生命体征平稳的尿道断裂的早期治疗,值得临床推广。