探讨膀胱全切并双"拖入式"改良Bricker术治疗结核性膀胱挛缩和尿道狭窄的安全性及可行性。

回顾性分析2020年4月至2020年9月喀什地区第一人民医院诊治的4例结核性挛缩膀胱患者临床资料特征，总结该手术要点及步骤。4例男性患者（36~76岁），术前影像学及T-SPOT诊断为泌尿系结核，膀胱容量<40 ml，合并后尿道炎性狭窄。4例患者均施行挛缩膀胱切除并双"拖入式"改良Bricker术。术中取中下腹正中切口，先切除挛缩膀胱，术中膀胱颈部多点活检后最大限度保留膀胱颈口组织并封闭。双"拖入式"改良Bricker术步骤：游离输尿管并保护其血运，置入7 F尿流改道支架管并固定；距离回盲部20 cm以上，寻找血管分支适合的回肠段（15~18 cm），近端3-0可吸收线缝合封闭；直线切割闭合器回肠侧侧吻合；将取出的回肠段清洁；拖入右侧造口腹壁，回肠末端浆肌层与皮下组织缝合两次固定，形成自然乳头3 cm突出于皮肤；将输尿管"拖入式"错位植入回肠对侧系膜腔内。

手术时间131~178 min，术中出血为50~400 ml。术后5~7 d拔除尿流改道支架管，术后住院时间5~7 d，无严重并发症。术后随访3~8个月肾功能恢复良好，Bricker造口乳头满意。3例患者恢复正常性生活。

膀胱全切并双"拖入式"改良Bricker术可作为难治性结核性膀胱挛缩和尿道狭窄的手术选择方式，其远期安全性尚需进一步验证。

To explore the experiences of the modified Bricker procedure with pull-through techniques for tuberculous contracted bladder and urethral stricture.

The data of patients with intractable urogenital tuberculosis from March 2020 to September 2020 in the First People’s Hospital of Kashgar Prefecture were analyzed retrospectively. Four males patients of with the age range from 36-76 years were admitted, and imaging confirmed contracted bladder with the maximum volume less than 40 ml and pathology demonstrated the inflammatory urethral stricture. All patients were eligible for cystectomy and Bricker surgery. After resected the tuberculous contracted bladder and sutured the bladder neck with the negative margins, the modified Bricker procedure in seven steps as follow: Firstly, Ureteral dissection and pigtail stent insertion; Isolation of the ileal loop (15-18) cm; Stapled side to side ileo-ileal anastomosis; Suturing the end of ileal Conduit; Urostomy fixation with the pull-through technique; The posterior ileo-ureteral anastomosis with pull-through technique were placed first and, the anterior sutures were completed; finally, Ileal conduct testing with blue dye.

The operating time was (131-178) min and the estimated blood loss was (50-400)ml,respectively. The average hospital stay was (5-7) days and the double stents were removed within 1 week postoperatively. No severe complications were observed and renal function imaging showed good effects of operation within three to eight months follow-up.

Cystectomy plus the modified Bricker procedure with pull-through techniques could be an option for selected cases with tuberculous contracted bladder and urethral stricture, but the long-term clinical effectiveness needed to be assessed.