Piaggio Lisandro, Myers Susan, Figueroa T Ernesto, Barthold Julia S, González Ricardo
Division of Urology, Department of Surgery, A.I. duPont Hospital for Children, Wilmington, DE, USA.
J Pediatr Urol. 2007 Jun;3(3):230-4. doi: 10.1016/j.jpurol.2006.07.002. Epub 2006 Sep 11.
Continent catheterizable channels (CCC) using the Mitrofanoff principle are essential for pediatric urinary tract reconstruction. There is controversy over the influence of type of CCC (appendix vs. Yang-Monti) and site of implantation (augmentation vs. native bladder) on outcome.
A retrospective record review was conducted of all patients undergoing CCC since 1999, excluding patients who underwent seromuscular colocystoplasty. We analyzed the type of channel, site of implantation, complications requiring re-operation, and the revision rate according to type of CCC, type of stoma, site of implantation (bladder vs. augmentation) and segment used for augmentation (ileum vs. sigmoid colon).
There were 41 patients with a mean age of 11.2 years and a mean follow-up of 33.3 months. Of these, 33 CCC were constructed with appendix and eight with a Yang-Monti technique (4 ileal, 4 sigmoid); 31 patients also had an enterocystoplasty (19 sigmoid, 9 ileal and 3 others). Overall revision rate was 27%; revision was required in 8/33 (24%) appendiceal and 3/8 (38%) Yang-Monti CCC (P=0.7). Revisions were required in 4/21 CCC implanted in the native bladder and 7/20 implanted in augmented bladder (P=0.3). The majority of revisions were at skin level.
Although there was no statistical difference in revision rate according to type of CCC, type of stoma or site of implantation, complications appeared to be more common in patients requiring a more complex reconstruction.
采用米氏原理构建的可控性尿流改道通道（CCC）对小儿尿路重建至关重要。CCC的类型（阑尾造瘘术与杨-蒙蒂术）及植入部位（膀胱扩大术与原位膀胱）对手术效果的影响存在争议。
对1999年以来所有接受CCC手术的患者进行回顾性记录分析，排除接受浆肌层结肠膀胱扩大术的患者。我们根据CCC类型、造口类型、植入部位（膀胱与膀胱扩大术）及用于膀胱扩大术的肠段（回肠与乙状结肠），分析通道类型、植入部位、需要再次手术的并发症及翻修率。
41例患者，平均年龄11.2岁，平均随访33.3个月。其中，33例CCC采用阑尾造瘘术构建，8例采用杨-蒙蒂技术构建（4例回肠，4例乙状结肠）；31例患者同时接受了肠膀胱扩大术（19例乙状结肠，9例回肠，3例其他）。总体翻修率为27%；33例阑尾造瘘术构建的CCC中有8例（24%）需要翻修，8例杨-蒙蒂术构建的CCC中有3例（38%）需要翻修（P = 0.7）。原位膀胱植入的21例CCC中有4例需要翻修，膀胱扩大术植入的20例CCC中有7例需要翻修（P = 0.3）。大多数翻修发生在皮肤层面。
尽管根据CCC类型、造口类型或植入部位，翻修率无统计学差异，但在需要更复杂重建的患者中，并发症似乎更常见。
