Zhang Xin-ru, Xu Yue-min, Feng Chao, Yu Jian-jun, Song Lu-jie, Fei Xiao-fang
Department of Urology, Shanghai Jiaotong University Affiliated Shanghai 6th Hospital, Shanghai, China.
Chin Med J (Engl). 2009 May 5;122(9):1087-91.
Continent cutaneous diversion (CCD) has been widely used in almost any lower urinary reconstruction. We have been continually trying to modify this procedure because of the high complications rate, especially as they relate to the efferent tube. In this study, we reported a modified procedure with a tapered ileum wrapped by the rectus abdominalis flap (RAMF) and assessed the feasibility of this new technique to achieve urinary continence.
A procedure in which two ileal segments were tapered and connected to a U-shaped reservoir was performed in ten dogs. A RAMF with its blood supply was wrapped around one of the tapered ileum. In control groups, the tapered ileum was brought to the abdominal skin. Urodynamic studies were conducted In the 1st, 3rd and 6th months post-operatively. The data of maximum inner pressure (MIP) and functional pressure length (FPL) in every group at each phase were recorded. Retrograde radiograms of the efferent limbs were performed before sacrifice.
MIP in the study group was significantly higher than that in the control group at each phase (P < 0.05). However, no significant differences in MIP or FPL were found in the study group between an empty and full reservoir. In the control group, MIP increased (P < 0.05) and FPL decreased significantly (P < 0.05) compared with an empty and full reservoir. Retrograde radiograms confirmed that efferent limbs were positioned straigh beneath the abdominal wall. Histological examination of the study group demonstrated a layer of striated muscle around the outside surface of the ileum.
The continent mechanism of tapered ileum can be enhanced by extra support from wrapped RAMF.
可控性皮肤造口术（CCD）已广泛应用于几乎所有的下尿路重建手术。由于并发症发生率高，尤其是与输出管相关的并发症，我们一直在不断尝试改进该手术。在本研究中，我们报告了一种改良手术，即采用腹直肌皮瓣（RAMF）包裹的锥形回肠，并评估了这种新技术实现尿失禁的可行性。
对10只犬实施了将两段回肠制成锥形并连接到一个U形贮尿囊的手术。将带有血供的RAMF包裹在其中一段锥形回肠周围。在对照组中，将锥形回肠引至腹部皮肤。在术后第1、3和6个月进行尿动力学研究。记录每个阶段每组的最大内压（MIP）和功能压力长度（FPL）数据。在处死前对输出支进行逆行造影。
在每个阶段，研究组的MIP均显著高于对照组（P<0.05）。然而，研究组在贮尿囊为空和充盈时，MIP或FPL均未发现显著差异。与贮尿囊为空和充盈时相比，对照组的MIP升高（P<0.05），FPL显著降低（P<0.05）。逆行造影证实输出支位于腹壁下方且位置笔直。研究组的组织学检查显示回肠外表面周围有一层横纹肌。
包裹的RAMF提供的额外支撑可增强锥形回肠的可控机制。
