ï»?!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> 耻骨上膀胱造瘘æœ?/title> <meta name="keywords" content="手术,耻骨上膀胱造瘘æœ?泌尿生殖外科手术" /> <meta name="description" content="" /> <link href="http://images.whrenai.com/news_images/new_css.css" rel="stylesheet" type="text/css"> <SCRIPT src="http://images.whrenai.com/by_images/showFlash.js"></SCRIPT> <script type="text/javascript" language="javascript" src="http://images.whrenai.com/js/copy.js "></script> <SCRIPT src="http://images.whrenai.com/by_images/showFlash.js"></SCRIPT> <script language="javascript" src="http://images.whrenai.com/zx.js"></script> <script language='javascript' src='/js/Page.js'></script> <script language='javascript' src='/js/Xmlhttp.js'></script> <script language='javascript' src='/common/InfoViewCount.aspx?ModelId=1&&Id=70648'></script> </head> <body> <!--LOGO--> <div class=z1> <div class=logo><img src="http://images.whrenai.com/tongyong/images/logo.gif" 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17:05:06　　　www.39.net　　　39</div> <!--time end--> <div class=key>关键è¯ï¼š<a href='/List.aspx?chid=18&Keyword=%e6%89%8b%e6%9c%af&FieldName=tagnamestr' target='_blank'>手术</a></div> <!--key end--> <div class=daodu></div> <!--ad end--> <div class=geyan><label><span>å¥åº·è°šè¯­</span></label></div> <!--geyan end--> <div class=concent fang=08-03-07 17:05:06> <br> <p>耻骨上膀胱造瘘æœ?/p> <img border="0" src="../../Files/Shoushu/200812714412835977801.jpg" > ⑴显露膀èƒ? <img border="0" src="../../Files/Shoushu/200812714412840677802.jpg" > ⑵å‘上分离腹膜åæŠ? <img border="0" src="../../Files/Shoushu/200812714412843777803.jpg" > ⑶切开膀胱å‰å£? <img border="0" src="../../Files/Shoushu/200812714412848477804.jpg" > ⑷手指深入膀胱内探查 <img border="0" src="../../Files/Shoushu/200812714412851577805.jpg" > ⑸置入导尿管，ç¼åˆè†€èƒ±å‰å£? <img border="0" src="../../Files/Shoushu/200812714412854677806.jpg" > ⑹膀胱å‰é—´éš™å¼•æµï¼Œç¼åˆåˆ‡å? å›?　耻骨上膀胱造瘘æœ? <p>[适应è¯]</p><p>1.膀胱内手术（如å–膀胱结石ã€å¼‚物），切除带蒂的膀胱肿瘤ã€è†€èƒ±æ†©å®¤ï¼Œä»¥åŠè†€èƒ±æŸä¼¤ä¿®è¡¥ç­‰ã€?/p><p>2.尿潴留引æµã€?/p><p>3.ç»è†€èƒ±åˆ‡é™¤å‰åˆ—腺或行尿é“会师术ã€?/p><p>[术å‰å‡†å¤‡]</p><p>1.术å‰æŽ§åˆ¶æ³Œå°¿ç³»æ„ŸæŸ“。改善全身情况如出血ã€ä¼‘å…‹ã€æ°´ç”µè§£è´¨å¹³è¡¡å¤±è°ƒç­‰ã€?/p><p>2.å‰è…¹éƒ¨ã€è…¹è‚¡æ²ŸåŠå¤–阴部剃毛，用肥皂水åŠæ¸©æ°´æ¸…洗，用新æ´å°”ç­æ¶ˆæ¯’ã€?/p><p>3.术å‰å°†å¯¼å°¿ç®¡ç½®å…¥è†€èƒ±ï¼Œå†²æ´—åŽï¼Œç”¨å†²æ´—ç›æ°´å……盈，导尿管留置，末端夹钳ã€?/p><p>[麻醉]</p><p>æˆäººé€‰ç”¨ç¡¬è†œå¤–麻醉或腰麻。全身情况ä¸è‰¯æˆ–高血压者å¯ç”¨å±€éº»ã€‚儿童采用硫喷妥钠基础麻醉加高ä½éª¶ç®¡éº»é†‰æˆ–局麻ã€?/p><p>[手术步骤]</p><p>1.体ä½ã€€ä»°å§ä½ç•¥å¤´ä½Žè„šé«˜ä½ï¼Œä½¿è…¹å†…肠管移å‘头侧ã€?/p><p>2.切å£ã€€ä½œè€»éª¨ä¸Šæ­£ä¸­åˆ‡å£ï¼Œé•?ï½?0cm，将腹直肌与锥状肌å‘两æ—分开，直达膀胱å‰é—´éš™ã€?/p><p>3.显露膀胱å‰å£ã€€ç”¨çº±å¸ƒè£¹æ‰‹æŒ‡å‘上é’性分离腹膜å‰è„‚肪与腹膜å折，显露出有纵行血管的膀胱å‰å£[å›? â‘?⑵]ã€?/p> <p>4.切开膀胱å‰å£ã€€åœ¨è†€èƒ±å‰å£ç¨é«˜ä½ç½®çš„中线两æ—，用两把组织钳夹ä½ï¼Œæ起膀胱å£ï¼Œåœ¨ä¸¤é’³ä¹‹é—´ç”¨æ³¨å°„器穿刺，抽å¸å‡ºå……盈膀胱的ç›æ°´åŽåˆ‡å¼€è†€èƒ±[å›? ⑶]。作膀胱造瘘术时切开1ï½?cm，å¯å®¹æ‰‹æŒ‡æŽ¢æŸ¥å³å¯ï¼›å…¶ä»–手术å¯é…Œæƒ…扩大。溢出的çŒæ´—液用å¸å¼•å™¨å¸å°½ã€?/p> <p>5.探查膀胱　用手指伸入膀胱内探查[å›? â‘·]，明确病å˜æƒ…况，如有å¯èƒ½ï¼Œåº”åŒæ—¶å°†ç—…å˜åŽ»é™¤ã€?/p> <p>6.ç¼åˆè†€èƒ±å‰å£ã€€å°†æ°”囊导尿管，伞状或蕈状导尿管置入膀胱切å£å†…。分两层ç¼åˆè†€èƒ±å£ã€‚内层用2-0铬制肠线全层间断ç¼åˆï¼ˆåœ¨æ— è‚ çº¿çš„情况下，也å¯é‡‡ç”¨ä¸çº¿é—´æ–­ç¼åˆè‚Œå±‚，但ä¸å¯ç©¿è¿‡ç²˜è†œå±‚，以å…导致术åŽç»“石形æˆï¼‰ï¼›å¤–层å†ä»¥4-0å·ä¸çº¿é—´æ–­ç¼åˆ[å›? ⑸]。导管ç»è…¹å£åˆ‡å£çš„上角引出ã€?/p> <p>7.引æµã€ç¼åˆã€€ç”¨ç”Ÿç†ç›æ°´å†²æ´—伤å£ï¼Œåœ¨è†€èƒ±å‰é—´éš™ç½®ä¸€é¦™çƒŸå¼•æµï¼Œç”±è…¹å£åˆ‡å£çš„下角引出。é€å±‚ç¼åˆè…¹ç›´è‚Œå‰éž˜ã€çš®ä¸‹ç»„织和皮肤。ç¼è…¹ç›´è‚Œæ—¶ï¼Œå¯åœ¨è†€èƒ±é¡¶éƒ¨å›ºå®šä¸€é’ˆï¼Œä»¥å…膀胱挛缩。导尿管需用皮肤ç¼çº¿çŽ¯ç»•ç»“扎固定，以å…脱出[å›? ⑹]ã€?/p> <p>[术中注æ„事项]</p><p>1.膀胱å£ä¸Šçš„动脉出血，必须当å³ç»“扎出血，以å…回缩å†å‡ºè¡€ã€?/p><p>2.分离腹膜å折时，应é¿å…分破，以防æ¼å°¿ï¼Œæ±¡æŸ“腹腔。在膀胱空虚ã€æŒ›ç¼©ã€ç ´è£‚时应防止将腹膜当作膀胱而误切入腹腔。一旦分破腹膜，应立å³ç¼åˆã€?/p><p>3.伞状或蕈状导尿管需自膀胱åŠè…¹å£åˆ‡å£é«˜ä½å¼•å‡ºï¼Œä»¥é˜²é•¿æœŸå¼•æµåŽè†€èƒ±æŒ›ç¼©ã€?/p><p>[术åŽå¤„ç†]</p><p>1.烟å·å¼å¼•æµä¸€èˆ¬åœ¨æœ¯åŽ24ï½?8å°æ—¶æ‹”除ã€?/p><p>2.耻骨上膀胱造瘘管于术åŽ10日内应注æ„防止脱出，以å…尿渗至周围组织。如需长期留置，应æ¯å‘¨æ›´æ¢1次。留置期间根æ®éœ€è¦ï¼Œç”¨æ¸©ç”Ÿç†ç›æ°´å†²æ´—膀胱，以防堵塞和感染ã€?/p><p>3.术åŽé¼“励病人多饮水ã€?/p><p>4.æ¯æ—¥æ›´æ¢åºŠè¾¹æ¶ˆæ¯’引æµè¢?次ã€?/p> </div> <!--concent end--> <div class=next> <p><a href="http://www.whrenai.com/ssdq/mnszwk/70647.html">å¯æŽ§æ€§å›žè‚ è†€èƒ±æœ¯</a></p> <p><a href="http://www.whrenai.com/ssdq/mnszwk/70649.html">膀胱部分切除术</a></p> </div> <!--next end--> <div class=fanhui><a href="http://www.whrenai.com"><img src="http://images.whrenai.com/news_images/back.gif" width="180" height="34" border="0" /></a><a href="http://dgt.zoosnet.net/LR/Chatpre.aspx?id=DGT13232427" target="_blank"><img 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