Farnham Scott B, Cookson Michael S
Department of Urologic Surgery, The Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232-2561, USA.
World J Urol. 2004 Sep;22(3):157-67. doi: 10.1007/s00345-004-0429-5. Epub 2004 Aug 13.
We comprehensively reviewed the published literature on urinary diversion, specifically examining the surgical complications associated with conduit, continent cutaneous diversion and orthotopic urinary diversion. Appropriate patient selection and adherence to proper surgical technique are of paramount importance in preventing surgical complications of urinary diversion. Complications can be broadly divided into those related to bowel, conduit or reservoir, stoma and ureterointestinal anastomosis. Each type of urinary diversion has unique characteristics predisposing to certain surgical complications as well as similarities related to intestinal surgery. With conduit urinary diversions, problems related to the stoma such as stomal stenosis and parastomal hernia present not uncommonly. With continent cutaneous diversion, complications include difficulties with catheterizing of the efferent limb, formation of pouch stones and urinary leakage. With orthotopic neobladder formation, voiding dysfunction manifesting as incontinence or hypercontinence may present unique challenges in patient management. Increased surgical experience and technical refinements have led to decreasing surgical complication rates for all types of diversion in contemporary series.
我们全面回顾了已发表的关于尿流改道的文献，特别研究了与导管、可控性皮肤造口尿流改道和原位尿流改道相关的手术并发症。在预防尿流改道的手术并发症方面，恰当的患者选择和遵循正确的手术技术至关重要。并发症大致可分为与肠道、导管或储尿囊、造口以及输尿管肠吻合相关的并发症。每种类型的尿流改道都有其独特的特征，易引发某些手术并发症，同时也有与肠道手术相关的相似之处。对于导管尿流改道，造口相关问题如造口狭窄和造口旁疝并不罕见。对于可控性皮肤造口尿流改道，并发症包括输出襻插管困难、储尿囊结石形成和尿液渗漏。对于原位新膀胱形成，表现为尿失禁或尿潴留的排尿功能障碍可能给患者管理带来独特挑战。在当代系列研究中，手术经验的增加和技术的改进已导致所有类型尿流改道的手术并发症发生率下降。
