Wood D N, Allen S E, Hussain M, Greenwell T J, Shah P J R
Institute of Urology, University College London, London, United Kingdom.
J Urol. 2004 Dec;172(6 Pt 1):2300-3. doi: 10.1097/01.ju.0000141140.56022.7a.
The ileal conduit is held to be the safest and simplest form of urinary diversion. There are few reports about long-term problems after ileal conduit formation, especially intractable urinary incontinence in females. We reviewed long-term stomal complications in patients with an ileal conduit.
Notes on 93 consecutive patients in whom an ileal conduit was created were reviewed. Information was collected on patient demographics, indications for an ileal conduit and long-term complications, in particular parastomal and incisional hernias, stomal retraction, stenosis or prolapse and the development of a redundant loop. Mean followup available was 63.4 months (range 1 to 434).
A total of 33 males with a mean age of 60.1 years (range 2 to 78) and 60 females with a mean age of 48.2 years (range 4 to 79) underwent ileal conduit diversion. The main indications for an ileal conduit were intractable incontinence in 44 patients (47%), cancer in 31 (33%) and interstitial cystitis in 8 (9%). In male, continent female and incontinent female patients A parastomal hernia developed in 3 (9%), 2 (9.5%) and 12 (31%), an incisional hernia developed in 1 (3%), 1 (4.8%) and 2 (5%), stomal retraction developed in 0, 2 (9.5%) and 12 (31%), stomal stenosis developed in 0 (0%), 1 (4.8%) and 6 (15.4%), and a redundant loop developed in 0 (0%), 2 (9.5%) and 5 (12.8%), respectively. A total of 23 patients (24.7%) required further surgery for stomal problems with 13 (57%) requiring more than 1 reoperation, of whom 9 were incontinent females.
An ileal conduit is associated with a stomal complication rate of 34.4% (61% in incontinent females and 18% in other patients) and a 4.3% incisional hernia rate. Reoperation is required for stomal complications in 24.7% of cases. Stomal complication rates and reoperation rates vary by sex and the indication for ileal conduit, and they are significantly higher for those performed for intractable urinary incontinence in females.
回肠膀胱术被认为是最安全、最简单的尿流改道方式。关于回肠膀胱术形成后的长期问题，尤其是女性难治性尿失禁的报道较少。我们回顾了回肠膀胱术患者的长期造口并发症。
回顾了连续93例行回肠膀胱术患者的病历。收集了患者的人口统计学信息、回肠膀胱术的适应证和长期并发症，特别是造口旁疝和切口疝、造口回缩、狭窄或脱垂以及多余肠袢的形成。平均随访时间为63.4个月（范围1至434个月）。
共有33例男性患者，平均年龄60.1岁（范围2至78岁），60例女性患者，平均年龄48.2岁（范围4至79岁）接受了回肠膀胱术尿流改道。回肠膀胱术的主要适应证为44例（47%）难治性尿失禁、31例（33%）癌症和8例（9%）间质性膀胱炎。在男性、可控性排尿的女性和尿失禁女性患者中，造口旁疝的发生率分别为3例（9%）、2例（9.5%）和12例（31%），切口疝的发生率分别为1例（3%）、1例（4.8%）和2例（5%），造口回缩的发生率分别为0例、2例（9.5%）和12例（31%），造口狭窄的发生率分别为0例（0%）、1例（4.8%）和6例（15.4%），多余肠袢的发生率分别为0例（0%）、2例（9.5%）和5例（12.8%）。共有23例患者（24.7%）因造口问题需要进一步手术，其中13例（57%）需要多次再次手术，其中9例为尿失禁女性。
回肠膀胱术的造口并发症发生率为34.4%（尿失禁女性为61%，其他患者为18%），切口疝发生率为4.3%。24.7%的病例因造口并发症需要再次手术。造口并发症发生率和再次手术率因性别和回肠膀胱术的适应证而异，女性难治性尿失禁患者的发生率显著更高。
