ABSTRACT
Objective To observe clinical curative effect of modified total cystectomy and Mainz Ⅱ neobladder. Methods Seventeen patients with bladder neoplasms were treated with modified total cystectomy and Mainz Ⅱ neobladder for urinary diversion. The paries posterior allantois with intestinum rectum and colon sigmoideum were taken 10 cm respectively, split the mesenterium edges, conduplicated and bilayer sutured from the junction of intestinum rectum and colon sigmoideum, bilateral ureters antireflux anastomosed respectively with colon sigmoideum and rectal papilla, then bilayer sutured paries anterior became Mainz allantois. Results There was no surgical mortality. The operative time was 340 ～ 420 mins (mean, 350 mins).Blood transfusion was 400 ～ 800 ml ( mean 600 ml). The follow-up was 4 ～ 18 months, urine and dejecta were shunt, uresis continence was fine and the operation had fewer severe complications. Conclusion Modified total cystectomy and Mainz Ⅱ neobladder to be an effective method for urinary diversion because of its simple operation, fewer severe complications, good uresis continence and high quality of life.
ABSTRACT
Objective To investigate the timing of beginning dialysis in CRF patients and the factors that might contribute to dialysis.Methods 117 non-diabetic CRF patients starting their first-time dialysis in our hemodialysis center from 2001.1 to 2002.12 were surveyed.The creatinine clearance (Ccr),creatinine concentration (Scr),symptoms of uremia,comorbidity and the conditions during first hemodialysis sessions were recorded.Factors from the points of patient,society,and physician that might affect the timing of dialysis were further analyzed.Results (1)In this study,the average level of Ccr was 4.18?3.26ml/min. (2)87.18% of the patients experienced nausea or vomiting before dialysis,55% manifested worsened nutritional status.71.79% occurred with cardiac morbidity and/or neuropathy,27.35% needed urgent hemodialysis. (3)98 cases (83.76%) seemed to start dialysis too late.The predominant reason was late diagnosis of CRF (76.52%).Conclusion (1)The timing of dialysis in our patients is generally late.(2)Disease screening and medical care of chronic kidney disease are key factors that affect the timing of dialysis.