东非地区应用低压结肠膀胱术（美因茨II式）治疗不可修复性膀胱阴道瘘和膀胱外翻的经验。
Experience with a low-pressure colonic pouch (Mainz II) urinary diversion for irreparable vesicovaginal fistula and bladder extrophy in East Africa.
作者信息
Morgan Mark A, Polan Mary Lake, Melecot Habte H, Debru Berhane, Sleemi Ambereen, Husain Amreen
机构信息
Department of Surgery, Fox Chase Cancer Center, Philadelphia, PA 19104, USA.
出版信息
Int Urogynecol J Pelvic Floor Dysfunct. 2009 Oct;20(10):1163-8. doi: 10.1007/s00192-009-0936-4. Epub 2009 Jun 17.
INTRODUCTION AND HYPOTHESIS
We report our experience with a low-pressure colonic pouch for urinary diversion in women with irreparable vesicovaginal fistulas and bladder extrophy.
METHODS
This is a case series of 35 women with irreparable vesicovaginal fistula who underwent urinary diversion and two cases performed for bladder extrophy.
RESULTS
Partial or complete loss of the urethra was present in over 90% of fistula cases. Fifty-five percent had prior vaginal repairs. The median length of stay was 21 days. Median follow-up for 29 (78%) patients was 18 months. Nighttime urinary incontinence occurred in 31%. Twenty-one (91%) of 23 patients had a serum creatinine <1.5 although all patients had evidence of acidosis. Two patients died 4 years after surgery from sepsis and renal failure.
CONCLUSIONS
Urinary diversion using the Mainz pouch II can be performed in the developing world with low perioperative morbidity and mortality. Acidosis and nighttime incontinence are the most common complications.
引言与假设
我们报告了在患有无法修复的膀胱阴道瘘和膀胱外翻的女性中，使用低压结肠膀胱替代术进行尿液改道的经验。
方法
这是一组35例患有无法修复的膀胱阴道瘘且接受尿液改道手术的女性病例系列，另有2例因膀胱外翻接受手术。
结果
超过90%的瘘管病例存在部分或完全尿道缺失。55%的患者曾接受过阴道修复手术。中位住院时间为21天。29例（78%）患者的中位随访时间为18个月。31%的患者出现夜间尿失禁。23例患者中有21例（91%）血清肌酐<1.5，尽管所有患者均有酸中毒迹象。两名患者术后4年因败血症和肾衰竭死亡。
结论
在发展中国家，使用美因茨II型膀胱替代术进行尿液改道可使围手术期发病率和死亡率较低。酸中毒和夜间尿失禁是最常见的并发症。
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