Thomas J C, Dietrich M S, Trusler L, DeMarco R T, Pope J C, Brock J W, Adams M C
Division of Pediatric Urology, Department of Urology, Vanderbilt University, Vanderbilt Children's Hospital, 2200 Children's Way, Nashville, TN 37232, USA.
J Urol. 2006 Oct;176(4 Pt 2):1816-20; discussion 1820. doi: 10.1016/S0022-5347(06)00610-0.
We reviewed our experience with continent catheterizable channels with interest in the timing of conduit related complications.
A retrospective review was performed of the outcome of continent catheterizable channels in all patients between 1998 and 2003 who had undergone construction of an antegrade continence enema and/or a Mitrofanoff procedure using appendix, small bowel or continent cutaneous vesicostomy. We performed a total of 117 such stomas in 37 male and 41 female patients 2.5 to 20 years old (mean age 8.9). For the antegrade continence enema we used appendix in 92% of cases, an ileal Yang-Monti tube in 6% and a cecal tube in 2%. For the continent catheterizable channel we used appendix in 43% of cases, a Yang-Monti tube in 38% and continent cutaneous vesicostomy in 19%.
Continence was achieved in 98% of patients. Followup was 6 to 71 months (mean 28.4). There were 27 channel related complications (23%). Stomal stenosis occurred in 7 antegrade continence enema procedures (14%) within 1 to 10 months (mean 6.2) and in 9 continent bladder channels (13%), including 5 continent cutaneous vesicostomies, within 1 to 24 months (mean 9.4) after surgery. False passages occurred in 5 antegrade continence enema procedures (10%) within 1 to 13 months (mean 3.6) and in 4 continent catheterizable channels (6%) within 1 to 13 months (mean 6.5) after surgery. Of patients with stomal stenosis 50% were treated with surgical revision, while the remainder was successfully treated with dilation. Most false passages were managed by catheter drainage alone. Reasons for revision were contained perforation, colovesical fistula and inability to catheterize. Patient noncompliance appeared to have a role in stomal stenosis.
Continent catheterizable stomas help patients achieve bowel and bladder continence. Stomal incontinence after reconstruction is rare. In our experience most stoma related complications occurred in the first year after reconstruction. Experience with more patients and longer followup will help determine whether such problems continue to accumulate with time or whether continent stomas function well with time, particularly after the initial period of healing.
我们回顾了可控性造口通道的经验，重点关注与通道相关并发症的发生时间。
对1998年至2003年间所有接受顺行性节制灌肠和/或使用阑尾、小肠或可控性皮肤膀胱造口术的米氏手术的患者中可控性造口通道的结果进行回顾性研究。我们共为37名男性和41名女性患者进行了117例此类造口手术，患者年龄在2.5至20岁之间（平均年龄8.9岁）。对于顺行性节制灌肠，92%的病例使用阑尾，6%使用回肠杨-蒙蒂管，2%使用盲肠管。对于可控性造口通道，43%的病例使用阑尾，38%使用杨-蒙蒂管，19%使用可控性皮肤膀胱造口术。
98%的患者实现了节制。随访时间为6至71个月（平均28.4个月）。有27例与通道相关的并发症（23%）。7例顺行性节制灌肠手术（14%）在术后1至10个月（平均6.2个月）出现造口狭窄，9例可控性膀胱通道（13%）包括5例可控性皮肤膀胱造口术在术后1至24个月（平均9.4个月）出现造口狭窄。5例顺行性节制灌肠手术（10%）在术后1至13个月（平均3.6个月）出现假道，4例可控性造口通道（6%）在术后1至13个月（平均6.5个月）出现假道。造口狭窄患者中50%接受了手术修复，其余患者通过扩张成功治疗。大多数假道仅通过导管引流处理。修复的原因包括穿孔、结肠膀胱瘘和无法插入导管。患者不依从似乎在造口狭窄中起作用。
可控性造口有助于患者实现肠道和膀胱节制。重建后造口失禁很少见。根据我们的经验，大多数与造口相关的并发症发生在重建后的第一年。更多患者和更长随访时间的经验将有助于确定这些问题是否会随着时间继续累积，或者可控性造口是否随着时间推移功能良好，特别是在初始愈合期之后。
