Lemelle J L, Simo A Kamdem, Schmitt M
From the Department of Paediatric Surgery, Children Hospital, Nancy University School of Medicine, Vandoeuvre les Nancy, France.
J Urol. 2004 Nov;172(5 Pt 1):1907-10. doi: 10.1097/01.ju.0000140448.36332.fc.
Continent conduits for Mitrofanoff and Malone procedures are widely used for incontinence management. Because the appendix is not always suitable or available, Monti proposed a transversely retubularized short segment of ileum. We present our experience and compare outcomes according to the type of conduit.
In a retrospective study from 1988 to 2003 case notes were reviewed specifying conduit characteristics, underlying disease, overall surgical management of incontinence and subsequent complications. Comparison was based on followup, details of complications and treatments.
In 32 men and 14 women with a total of 65 conduits (Mitrofanoff in 41 and Malone procedure in 24) the condition was spina bifida in 29, bladder exstrophy in 5 and sacral agenesia in 3. Other cases included various origins. Mean age at operation was 14.2 years (range 1 to 31). Mean followup was 5.3 years (range 1 to 14.7). Appendix was used in 23 cases and a Yang-Monti channel was performed in 18 (ileum in 7 and sigmoid in 11) for urinary diversion. The Malone procedure was performed using appendix in 11 cases and a Yang-Monti tube in 13. At followup 61 conduits (93.8%) were in use and 4 (6.2%) were abandoned. Complications were cutaneous stenosis, kink blockage and stomal leakage. No significant differences were observed between the types and purposes of the conduit.
With constant availability and various possibilities of construction the Yang-Monti channel is recommended for continent diversion creation when appendix does not look suitable or is already in use or absent.
用于米氏手术和马龙手术的可控性尿流改道术广泛应用于尿失禁的治疗。由于阑尾并非总是合适或可用，蒙蒂提出了一种横向再管状化的短段回肠。我们介绍我们的经验，并根据尿流改道类型比较结果。
在一项回顾性研究中，我们查阅了1988年至2003年的病例记录，详细记录了尿流改道的特征、基础疾病、尿失禁的整体手术治疗及后续并发症。比较基于随访情况、并发症细节及治疗方法。
32例男性和14例女性共65例尿流改道（米氏手术41例，马龙手术24例），其中脊柱裂29例，膀胱外翻5例，骶骨发育不全3例。其他病例病因各异。手术平均年龄为14.2岁（范围1至31岁）。平均随访时间为5.3年（范围1至14.7年）。23例使用阑尾，18例进行了杨-蒙蒂通道手术（7例用回肠，11例用乙状结肠）用于尿液转流。11例马龙手术使用阑尾，13例使用杨-蒙蒂管。随访时，61例尿流改道（93.8%）仍在使用，4例（6.2%）已废弃。并发症包括皮肤狭窄、扭结阻塞和造口漏尿。在尿流改道的类型和用途之间未观察到显著差异。
鉴于其持续可用性和多种构建可能性，当阑尾不合适、已被使用或不存在时，推荐使用杨-蒙蒂通道进行可控性尿流改道。
