Hitchcock Rowena Jane, Sadiq Mohammad Javaid
Department of Paediatric Surgery, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
J Pediatr Urol. 2007 Apr;3(2):104-8. doi: 10.1016/j.jpurol.2006.06.010. Epub 2006 Sep 5.
A modified technique of vesicostomy is described using a gastrostomy button, which could be used as a continent urinary stoma in children with incomplete voiding.
From 1998 to 2005, 21 children aged between 4 days and 16 years underwent insertion of button vesicostomy to permit bladder drainage. They had incomplete bladder emptying and clean intermittent urethral catheterization (CIC) could not be established. In six of 23 procedures, the button was placed through a classical vesicostomy (3) or via a suprapubic catheter tract (3). In 17, a standardized technique of button vesicostomy stoma formation was used. The median follow up was 2.5 years (0.75-8 years).
Patients were selected on the basis of clinical need. Idiopathic hypotonic bladder was the most common indication (9), followed by anorectal malformation (5), neuropathic bladder and posterior urethral valves (2 each), traumatic rupture of urethra (1), visceral myopathy (1) and posterior urethritis (1). Granuloma formation around vesicostomy button was observed in five patients. Local infection was observed in three patients and urinary tract infection in four. No peri-button leakage occurred in the standardized button stomas but was seen in all three of the buttons placed in classical vesicostomies, and transient leakage occurred in one of the three patients with a button placed via a suprapubic catheter tract. The median duration of use of vesicostomy button was 11 months (2-30 months). In eight patients, bladder function improved and intermittent drainage was no longer required. Three patients are still using the button, four progressed to Mitrofanoff, four started CIC per urethra, and two reverted to continuous drainage.
Button vesicostomy is a useful addition to the options available for a catheterizable continent urinary stoma in children in the short or medium term. The risk of major complications was low although minor complications were common, and the technique was well accepted by patients and parents.
描述一种使用胃造口纽扣的改良膀胱造口术，可用于排尿不完全的儿童作为可控性尿流改道术。
1998年至2005年，21例年龄在4天至16岁之间的儿童接受了纽扣式膀胱造口术以进行膀胱引流。他们膀胱排空不完全，无法进行清洁间歇性导尿（CIC）。在23例手术中的6例中，纽扣通过经典膀胱造口术（3例）或经耻骨上导管通道（3例）置入。在17例中，采用了标准化的纽扣式膀胱造口术造口形成技术。中位随访时间为2.5年（0.75 - 8年）。
根据临床需要选择患者。特发性低张性膀胱是最常见的适应证（9例），其次是肛门直肠畸形（5例）、神经源性膀胱和后尿道瓣膜（各2例）、尿道创伤性破裂（1例）、内脏肌病（1例）和后尿道炎（1例）。5例患者观察到膀胱造口纽扣周围形成肉芽肿。3例患者出现局部感染，4例出现尿路感染。标准化纽扣造口处未发生纽扣周围渗漏，但在经典膀胱造口术中置入的所有3个纽扣中均出现渗漏，经耻骨上导管通道置入纽扣的3例患者中有1例出现短暂渗漏。膀胱造口纽扣的中位使用时间为11个月（2 - 30个月）。8例患者膀胱功能改善，不再需要间歇性引流。3例患者仍在使用纽扣，4例进展为米氏术，4例开始经尿道进行CIC，2例恢复为持续引流。
纽扣式膀胱造口术是儿童中短期可控性尿流改道术的有用补充。尽管轻微并发症常见，但主要并发症风险较低，该技术为患者和家长所接受。
