Wagner Matthew, Bayne Aaron, Daneshmand Siamak
Section of Urologic Oncology, Division of Urology and Renal Transplantation, Oregon Health & Sciences University, Portland, Oregon 97239, USA.
Urology. 2008 Oct;72(4):828-31. doi: 10.1016/j.urology.2008.06.015. Epub 2008 Jul 31.
To report 8 cases using the Yang-Monti channel with ileum for adult continent cutaneous urinary diversion.
From 2004 to 2006, 108 patients underwent urinary diversion, 8 of whom had a continent cutaneous reservoir using the Yang-Monti principle. Channels were created by transversely retubularizing 2 to 3 cm of ileum. Indications, technique, complications, and outcomes, such as continence and ease of channel catheterization, are reported.
Five patients underwent a right colon reservoir urinary reconstruction after extirpative surgery. Orthotopic neobladders were not performed, owing to anatomic or oncologic concerns. Two additional patients underwent an augmentation, with 1 undergoing an Indiana pouch revision. All urinary reservoirs but 1 were connected to the umbilicus. Two strictures occurred, which were treated with in-office dilation. Incontinence was identified in 2 patients and successfully treated with dextran microspheres injections. All patients were continent at final follow-up. Seven patients continue to perform intermittent catheterization, and 1 patient is managed with an indwelling catheter, owing to comorbidities.
The Yang-Monti channel using ileum is an alternative as a neo-appendicoumbilicostomy in construction of continent cutaneous urinary diversion. The channel is surgically versatile and can be used in the creation of a right colon pouch when the appendix is unavailable.
报告8例采用回肠构建杨-蒙蒂通道用于成人可控性皮肤造口膀胱术的病例。
2004年至2006年期间，108例患者接受了尿流改道术，其中8例采用杨-蒙蒂原理构建了可控性皮肤贮尿囊。通过将2至3厘米的回肠横向重新管状化来创建通道。报告了手术适应症、技术、并发症以及诸如控尿和通道插管难易程度等结果。
5例患者在根治性手术后进行了右结肠贮尿囊尿流重建。由于解剖或肿瘤学方面的考虑，未进行原位新膀胱术。另外2例患者进行了扩大手术，其中1例进行了印第安纳袋修复术。除1个贮尿囊外，所有贮尿囊均与脐部相连。发生了2例狭窄，通过门诊扩张进行了治疗。2例患者出现尿失禁，通过注射葡聚糖微球成功治疗。所有患者在最后随访时均能控尿。7例患者继续进行间歇性导尿，1例患者由于合并症使用留置导尿管。
采用回肠的杨-蒙蒂通道可作为一种替代方法，用于构建可控性皮肤造口膀胱术的新型阑尾脐造口术。该通道在手术上具有多种用途，当阑尾不可用时可用于构建右结肠袋。
