Ahlering T E, Gholdoian G, Skarecky D, Weinberg A C, Wilson T G
Division of Urology, University of California Irvine Medical Center, Orange, California, USA.
J Urol. 2000 May;163(5):1428-31.
We report a simplified technique for converting an existing conduit to an Indiana pouch as well as short and long-term results.
From May 1988 to February 1998 we evaluated short and long-term outcome and complications in 23 patients 14 to 82 years old (average age 51.8) who underwent conversion of a conduit to an Indiana pouch. When no obstruction of the existing ureteroileal anastomoses was identified, the conduit was freed from the abdominal wall and surrounding bowel. The proximal conduit and ureteral anastomoses were not dissected. The conduit was opened along the antimesenteric wall proximal to the ureteral anastomoses and attached to 25 to 28 cm. of detubularized right colon as a refluxing Studer limb. The pouch was completed in the usual fashion and the stoma was matured at a virgin site.
Surgical indications included stomal complications in 10 patients, an infected nonfunctioning kidney in 2 and patient preference in 11. There were no perioperative deaths although 3 patients died of cancer progression. Average operative time was 6.6 hours, estimated blood loss 518 cc and length of stay 7.8 days. Average followup after conversion was 4.7 years (range 0.2 to 11.0). Six late complications developed in 4 cases, including pyelonephritis in 2, severe pouchitis in 1, dehydration in 1 and stomal revision in 2. Renal function was well preserved with an average preoperative and postoperative creatinine of 0.91 and 1.14 mg./dl., respectively.
This technique simplifies conversion and decreases bowel requirements. The low complication rate and stable serum creatinine support the finding that conversion of a conduit to an Indiana pouch is a safe, viable procedure.
我们报告一种将现有导管改造成印第安纳袋的简化技术以及短期和长期结果。
1988年5月至1998年2月，我们评估了23例年龄在14至82岁（平均年龄51.8岁）的患者，这些患者接受了将导管改造成印第安纳袋的手术，观察其短期和长期结果及并发症情况。当未发现现有输尿管回肠吻合口存在梗阻时，将导管从腹壁和周围肠管游离出来。近端导管和输尿管吻合口未进行解剖。在输尿管吻合口近端沿系膜对侧缘打开导管，并与25至28厘米去管化的右结肠相连，作为反流性Studer襻。以常规方式完成袋体构建，并在新部位使造口成熟。
手术指征包括10例患者存在造口并发症，2例患者有感染性无功能肾，11例患者出于个人意愿。尽管有3例患者死于癌症进展，但无围手术期死亡病例。平均手术时间为6.6小时，估计失血量为518毫升，住院时间为7.8天。改造后的平均随访时间为4.7年（范围为0.2至11.0年）。4例患者出现6例晚期并发症，包括2例肾盂肾炎、1例严重袋炎、1例脱水和2例造口修复。肾功能得到良好保留，术前和术后肌酐平均分别为0.91和1.14毫克/分升。
该技术简化了改造过程并减少了肠管需求。低并发症发生率和稳定的血清肌酐水平支持了将导管改造成印第安纳袋是一种安全、可行手术的观点。
