Kiyokawa H, Igawa Y, Muraishi O, Tamai C, Nishizawa O
Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan.
J Urol. 1999 Sep;162(3 Pt 1):902-4. doi: 10.1097/00005392-199909010-00087.
To develop more simple and effective anti-reflux techniques applicable to the ileal reservoir, we examined the usefulness of a novel anti-reflux uretero-ileal anastomosis creating a flap valve mechanism.
Five dogs were used. A 4 cm. long ileal segment was isolated and its oral part (2.5 cm.) was detubularized. The detubularized ileal plate was anastomosed to the dome of the bladder. The left ureter was cut and its proximal end was spatulated and anastomosed end-to-side to the ileal plate. The end of the 1.5 cm. long afferent limb (non-detubularized part of the ileal segment) was closed and fixed down to the ileal plate to create an extramural tunnel. In this way, the reimplanted ureter was covered by the afferent limb. The dogs were evaluated between 3 and 4 months postoperatively.
None of the 5 dogs used showed vesico-ureteral reflux or hydronephrosis. Histological examination showed an intact ureter enclosed with a normal ileal wall.
Our proposed anti-reflux uretero-ileal anastomosis is simple and reliable. This technique may be suitable for applying to a urinary reservoir, especially as an alternative to the intussuscepted nipple valve.
为开发更简单有效的适用于回肠储尿囊的抗反流技术，我们研究了一种新型抗反流输尿管 - 回肠吻合术形成瓣阀机制的实用性。
使用5只狗。分离出一段4厘米长的回肠段，其近侧部分（2.5厘米）去管化。将去管化的回肠片与膀胱顶部吻合。切断左输尿管，将其近端做成鱼嘴状并与回肠片端侧吻合。将1.5厘米长的传入支（回肠段未去管化部分）的末端封闭并固定在回肠片上以形成壁外隧道。通过这种方式，再植输尿管被传入支覆盖。在术后3至4个月对狗进行评估。
所使用的5只狗均未出现膀胱输尿管反流或肾积水。组织学检查显示输尿管完整，被正常的回肠壁包裹。
我们提出的抗反流输尿管 - 回肠吻合术简单可靠。该技术可能适用于尿储器，尤其是作为套叠乳头瓣的替代方法。
