The Experiment Study And Clinical Application Of The Orthotopic Total Taeniamyotomy Sigmoid-colon Reservoir

Permanent forms of urinary diversion are primarily appicable to patients with bladder cancer who require cystectomy. Currently, the classical ideal conduit as well as the stomal continent urinary diversions have given way to the increasingly frequent use of most the bladder substitutions. The detubularized bowel were widely used, such as hemi-koch reservoir and reservoir described by Studer, etc. The ideal neobladder should be characterized by low?pressure, good capacity, high compliance, surgical simplicity and short operation time. Although detubularized bowel has get the most salient technique features: good capacity, low pressure storage, detubularization increase surgical difficulty, and operation time, and postoperative complications. Based on Alcini's study using cecocolone for bladder replacement by multiple transverse taeniamyotomy. Since 1995, our department had developed the total teaniamyotomy cecocolon reservoir and got satisfactory clinical outcomes. And the mechanism of large volume and low pressure of the reservoir after teaniamytomy had been proved by our following experiments. Thought about the proximity of the sigmoid-colon to the membranous urethra and its little or absent impact of loss on the nutritional status, we designed this experiment using the sigmoid-colon by total teaniamytomy to make neobladder, and study this new reservoir抯 urodynamic characteristics. It's aim to master the way to make the reservoir and perform the reservoir urodynamics to guide for clinical application. In this experiment, 18 living pigs were divided into 3 groups: A: Tubular bowel neobladder; B: Detubularized bowel neobladder; C: Total teaniamytomy sigmoid-colon reservoirs. This included determination of the largest volume, the volume-pressure relationship, and operation time. Also we measured the perimeter and the volume of both tubular sigmoid-colon and total teaniamyotomy sigmoid-olon reservoir in human body. Result: 1 The largest volume (ml): A: 260.83 ?9.70; B: 294.17 ?12.42; C: 408.33?10.80. 2 The volume at the same pressure 2OcmH1O (ml): A: 120.83?5.85; B: 274.17?10.86; C: 320.00?15.17. Time of making reservior (h): A: 2.20?.15; B: 3.62?0.86; C: 2.33?.10. 4. Human body's sigmoid-colon perimeter and volume (cm and ml): perimeter: 14.44?0.74 and 17.74?0.95; volume: 285.00?.9land 446.00 ?22.19. Conclusions: 1 .The total teaniamyotomy sigmoid-colon reservoir showed the lower pressure and good capacity and the better urodynamic characteristics; 2.The operation of total teaniamyotomy sigmoid-colon neobladder is simpler and easy to perform, also has short operation time; 3.This neobladder is first invested in our experiment. It's deserved for clinical application.