Fisch Margit, Thüroff Joachim W
Center of Urology and Paediatric Urology, Asklepios Klinik Harburg, Hamburg, Germany.
BJU Int. 2008 Nov;102(9 Pt B):1314-9. doi: 10.1111/j.1464-410X.2008.07976.x.
Continent urinary diversion requires the creation of a reservoir, ureteric implantation and establishment of a continence mechanism in the efferent segment. This review is a short overview on the history of different techniques in current use. Reservoirs with high volume and low pressure can be fashioned by antimesenteric opening and spherical reconfiguration of the bowel. Previously, techniques for ureteric implantation were simply transferred to continent urinary diversion. Currently the need for antirefluxive ureteric implantation techniques is questioned and there is a trend towards refluxive implantation. To create a continence mechanism, simple and reproducible procedures. e.g. the incorporation of the efferent segment into the pouch wall (e.g. appendix stoma, flap valve T mechanism, serosal-lined extramural tunnel) have been developed. Long-term data for different surgical techniques show excellent continence and acceptable complication rates.
可控性尿流改道术需要构建一个贮尿囊、输尿管植入以及在输出段建立控尿机制。本综述是对当前使用的不同技术的历史进行的简要概述。通过对肠管进行系膜对侧开口和球形重塑可形成大容量、低压的贮尿囊。以前，输尿管植入技术只是简单地应用于可控性尿流改道术。目前，抗反流输尿管植入技术的必要性受到质疑，并且有向反流性植入发展的趋势。为了建立控尿机制，已经开发出了简单且可重复的方法，例如将输出段纳入囊壁（如阑尾造口、瓣阀T形机制、浆膜内衬的壁外隧道）。不同手术技术的长期数据显示出良好的控尿效果和可接受的并发症发生率。
