Abdallah Mohamed M, Bissada Nabil K
Faculty of Medicine, Menoufia University, Menoufia, Egypt, and University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA.
J Urol. 2007 Sep;178(3 Pt 1):1113-6. doi: 10.1016/j.juro.2007.05.007. Epub 2007 Jul 25.
An ileal conduit is created in about half of all urinary diversions. Difficulties in constructing an abdominal stoma in morbidly obese patients can be challenging, especially if the patient has a short mesentery. Excessive traction on the mesentery in an attempt to pass the distal segment of ileum through the thick abdominal wall may result in ischemia of the whole segment blood supply. We evaluated the safety of freeing the terminal portion of the conduit from its mesentery to facilitate easy passage of the conduit through the abdominal wall and decrease the incidence of parastomal hernia.
Five domestic pigs were used for this study. In each subject a 10 cm segment of ileum was isolated to form the ileal loop and bowel continuity was established. A 3 to 4 cm segment of the distal ileal loop was freed from its mesenteric blood supply. This segment of the loop was passed through the appropriate defect in the abdominal wall to the skin and an everted stoma was constructed. Postoperatively the animals were followed for 1 month and then sacrificed. The ileal loop with its mesentery and surrounding skin were harvested en bloc and sent for gross and histological examination.
Mean postoperative time was 30 days (range 29 to 32). No mortality or perioperative complications were recorded. All animals had an uneventful postoperative course until the scheduled time for specimen collection. At harvesting the stoma remained pink in all animals. Gross examination and calibration demonstrated no evidence of narrowing or stenosis. Histological examination revealed no ischemic changes. The mucosa of the entire ileal loop was uniform and healthy.
Freeing the mesenteric edge of the ileal loop is safe. This finding has an important application for allowing easy construction of an ileal loop or continent cutaneous diversion stoma in morbidly obese patients. This finding is also applicable when constructing terminal ileostomy or colostomy stoma in select patients.
在所有尿流改道手术中，约一半会创建回肠导管。在病态肥胖患者中构建腹部造口存在困难，具有挑战性，尤其是当患者肠系膜较短时。试图将回肠远端段穿过厚厚的腹壁时，对肠系膜过度牵拉可能导致整个段血液供应缺血。我们评估了将导管末端部分从其肠系膜游离以促进导管轻松穿过腹壁并降低造口旁疝发生率的安全性。
本研究使用了5头家猪。在每只动物中分离出一段10厘米的回肠形成回肠袢，并建立肠道连续性。将回肠袢远端3至4厘米的一段从其肠系膜血液供应中游离出来。将该段袢穿过腹壁上的适当缺损至皮肤，并构建外翻造口。术后对动物随访1个月，然后处死。将带有肠系膜和周围皮肤的回肠袢整块切除并送去进行大体和组织学检查。
术后平均时间为30天（范围29至32天）。未记录到死亡或围手术期并发症。所有动物在预定的标本采集时间前术后过程均顺利。在取材时，所有动物的造口均保持粉红色。大体检查和校准未发现狭窄或缩窄的证据。组织学检查未发现缺血性改变。整个回肠袢的黏膜均匀且健康。
游离回肠袢的肠系膜边缘是安全的。这一发现对于在病态肥胖患者中轻松构建回肠袢或可控性皮肤造口具有重要应用价值。这一发现也适用于为特定患者构建末端回肠造口术或结肠造口术造口时。
