Castellan M A, Gosalbez R, Labbie A, Monti P R
Department of Urology, Miami Children's Hospital, Florida, USA.
Urology. 1999 Jul;54(1):152-6. doi: 10.1016/s0090-4295(99)00046-1.
Monti et al. recently described a technique for the construction of a continent catheterizable conduit using short segments of small bowel in a canine model. We review our experience with 25 adult and pediatric patients in whom the Monti procedure was used in their reconstructive efforts.
Since October 1995, 25 patients (13 males and 12 females), aged 4 to 67 years (median 29), underwent the construction of 29 catheterizable stomas with a short (2.5 cm) segment of bowel following the Monti technique. Twenty-seven tubes were created as urinary stomas and two as part of the Malone antegrade continent enema procedure (MACE). Continence is based on the Mitrofanoff flap valve mechanism. Tubes were created when the appendix was unavailable as part of urinary reconstructive efforts or after exenterative oncologic surgery of the lower urinary tract. Tubes were created using ileum (24) and sigmoid colon (5). Ten tubes (34.5%) were done in combination with a simultaneous bowel patch in the same pedicle for bladder augmentation. Tubes were implanted in the ileum (13), bladder (9), sigmoid colon (3), stomach (1), and descending colon (1). The two tubes created to do a MACE procedure were anastomosed into the cecum. Double tubes were necessary in 7 adult patients for adequate length. The length of the tubes varied from 6 to 14 cm.
Follow-up ranged between 3 and 26 months (mean 13). One adult patient (4%) with bladder cancer died of myocardial infarction 14 days postoperatively. Three patients (12%) received a new Monti tube because of ischemic stenosis of the tube. All of them were continent at a follow-up of 1, 6, and 20 months, respectively. Two patients (8%) experienced leakage through the stoma, requiring additional procedures and pharmacologic manipulation to become continent. All patients used intermittent catheterization through the stoma without problems.
Although the appendix remains the tissue of choice, the Monti procedure has substantial advantages over other efferent catheterizable tubes, including the need for a very short segment of bowel (2.5 cm), adequate lumen size (16F to 18F), length, reliable blood supply, and the versatility to combine with a simultaneous bowel patch in the same pedicle for bladder augmentation.
蒙蒂等人最近描述了一种在犬模型中使用小肠短节段构建可控性贮尿囊的技术。我们回顾了25例成年和儿科患者应用蒙蒂手术进行重建的经验。
自1995年10月以来，25例患者（13例男性和12例女性），年龄4至67岁（中位数29岁），按照蒙蒂技术用短（2.5厘米）肠段构建了29个可控性造口。27个造口作为尿流改道造口，2个作为马龙顺行可控性灌肠术（MACE）的一部分。控尿基于米特罗法诺夫瓣机制。当阑尾不可用时，作为尿流重建的一部分或在下尿路肿瘤切除术后，用回肠（24例）和乙状结肠（5例）构建造口。10个造口（34.５%）在同一蒂部同时进行肠片修补以扩大膀胱。造口植入回肠（13例）、膀胱（9例）、乙状结肠（3例）、胃（1例）和降结肠（1例）。为进行MACE手术构建的2个造口吻合至盲肠。7例成年患者需要双造口以获得足够长度。造口长度为6至14厘米。
随访时间为3至26个月（平均13个月）。1例成年膀胱癌患者术后14天死于心肌梗死（4%）。3例患者（12%）因造口缺血性狭窄接受了新的蒙蒂造口。在随访1个月、6个月和20个月时，他们均能控尿。2例患者（8%）造口出现渗漏，需要额外手术和药物处理以实现控尿。所有患者通过造口进行间歇性导尿均无问题。
尽管阑尾仍是首选组织，但蒙蒂手术相对于其他输出可控性造口管具有显著优势，包括所需肠段非常短（2.5厘米）、管腔大小合适（16F至18F）、长度足够、血供可靠以及可在同一蒂部同时进行肠片修补以扩大膀胱的多功能性。
