Landau Ezekiel H, Gofrit Ofer N, Cipele Helio, Hardak Benjamin, Duvdevani Mordechai, Pode Dov, Shenfeld Ofer Z
Pediatric Urology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
J Urol. 2008 Oct;180(4 Suppl):1761-5; discussion 1765-6. doi: 10.1016/j.juro.2008.04.070. Epub 2008 Aug 21.
Stricture prevention, avoiding exposed mucosa and cosmesis are important considerations when constructing continent abdominal stomas. We analyzed our results of continent abdominal stomas using the umbilicus and 2 types of lower abdominal stomas, that is the V-quadrilateral-Z technique and the tubular skin flap.
Patient charts were reviewed retrospectively. All patients with a continent abdominal stoma were included in our study. Patients were divided into 3 groups according to type of stoma, including umbilicus, tubular skin flap and V-quadrilateral-Z. The groups were compared regarding demographics, etiology, success, complications and the need for revision.
A total of 40 incontinent patients were included in our study. All underwent Mitrofanoff urinary diversion (37) and/or Malone antegrade continence enema construction (13) between 1993 and 2007. The umbilicus was used for 31 conduits, the V-quadrilateral-Z was used for 8 and the tubular skin flap was used for 11. Patient age and gender, and the etiology of incontinence were similar in the 3 groups. All patients achieved good cosmesis with a hidden bowel mucosa. In the V-quadrilateral-Z group no patient had stomal stenosis. Five patients (45%) in the tubular skin flap group required dilation or revision for obstruction or stenosis, which was successful in 4. Eight umbilical conduits (25%) had to be dilated or revised due to stomal stenosis (6) and conduit obstruction (2).
Initial results with the V-quadrilateral-Z flap show its superiority over the tubular skin flap and the umbilicus for stomal construction in patients with a Mitrofanoff or Malone antegrade continence enema conduit.
在构建可控性腹部造口时，预防狭窄、避免黏膜外露和美观是重要的考量因素。我们分析了使用脐部以及两种下腹造口（即V形四边形-Z技术和管状皮瓣）构建可控性腹部造口的结果。
对患者病历进行回顾性分析。所有行可控性腹部造口的患者均纳入本研究。根据造口类型将患者分为3组，包括脐部、管状皮瓣和V形四边形-Z组。比较各组的人口统计学特征、病因、成功率、并发症及修复需求。
本研究共纳入40例大小便失禁患者。所有患者在1993年至2007年间均接受了米氏可控性尿流改道术（37例）和/或马龙顺行性可控灌肠造瘘术（13例）。31例使用脐部构建导管，8例使用V形四边形-Z技术，11例使用管状皮瓣。3组患者的年龄、性别及失禁病因相似。所有患者均实现了良好的美观效果且肠黏膜隐匿。V形四边形-Z组无患者出现造口狭窄。管状皮瓣组有5例患者（45%）因梗阻或狭窄需要扩张或修复，其中4例成功。8例脐部导管（25%）因造口狭窄（6例）和导管梗阻（2例）需要扩张或修复。
V形四边形-Z皮瓣的初步结果显示，在为行米氏或马龙顺行性可控灌肠导管术的患者构建造口时，其优于管状皮瓣和脐部。
