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目的 :介绍并评价改良 Sigma手术的可控性尿流改道临床疗效。方法 :14例膀胱、前列腺肿瘤患者接受该手术。取 2 5cm左右乙状结肠折叠后全层切开 ,再缝合成低压袋 ,低压袋顶端固定在骶岬处 ,两输尿管末端合并吻合并外翻形成乳头 ,从低压袋上方引入再植。结果 :术后发生直肠阴道瘘 1例 ,经横结肠造口过渡后自愈 ;1例左肾积水伴上尿路感染 ,经输尿管顺行扩张后恢复正常 ,该患者术后 3个月发生严重低血钾 ,经补充枸橼酸钾后治愈。平均随访 2 2 .5个月 ,本组未见尿失禁、上尿路感染。 3例肿瘤复发 ,2例肉瘤复发患者于术后 6个月后死亡。结论 :改良 Sigma手术费时短 ,对肠管扰动小 ,操作简便 ,术后尿控满意 ,无上尿路积水、感染及明显酸碱电解质紊乱 ,明显提高了患者生活质量。
Purpose : To introduce and evaluate the clinical efficacy of controlled urinary diversion of modified Sigma. Methods: Fourteen patients with bladder and prostate tumors underwent the operation. Take about 5cm sigmoid colon folded after full-thickness, and then sewn synthetic low-pressure bag, the top of the low-pressure bag fixed in the ankle, the two ends of the ureter with anastomosis and valgus to form a nipple, replanted from the top of the low-pressure bag. RESULTS: One case of recto-vaginal fistula occurred postoperatively and self-healed after transvaginal colostomy transition. One case of left hydronephrosis with upper urinary tract infection returned to normal after antegrade ureteral dilatation. This patient was severe at 3 months after operation. Hypokalemia, cured after supplemental potassium citrate. The average follow-up period was 22.5 months. There was no urinary incontinence or upper urinary tract infection in this group. Three patients had tumor recurrence. Two patients with recurrence of sarcoma died 6 months after surgery. Conclusion: The modified Sigma procedure takes a short time, has little disturbance to the intestinal tract, is easy to operate, and is satisfactory for postoperative urinary control. It has no upper urinary hydrops, infection, and obvious acid-base electrolyte imbalance, which significantly improves the quality of life of patients.