Oncology Center, Mansoura University, Mansoura, Egypt.
J Surg Res. 2011 Apr;166(2):e129-33. doi: 10.1016/j.jss.2010.08.003. Epub 2010 Sep 20.
Cosmesis, better function, and stomal stricture avoidance are important issues in constructing continent urinary abdominal stomas for bladder cancer patients when orthotopic urinary diversion is not feasible. This study aims to evaluate the outcome of continent catheterizable umbilical low-pressure intestinal pouch incorporating a new split ileal end anti-reflux technique.
Twenty-three patients underwent a continent umbilical low-pressure intestinal pouch incorporating a new seromuscular antireflux technique (split ileal end) after radical cystectomy when orthotopic reconstruction was not feasible. Mean operative time was 210 min (130 min for radical cystectomy and 80 min for reconstruction of the pouch). The mean follow-up after surgery was 18 mo (range 6-30 mo).
The most common early postoperative complications were urinary leak that occurred in nine patients: seven were conservatively managed and two by re-exploration. Late postoperative complications occurred in eight patients, of whom three developed stomal stenosis and treated successfully with repeated dilatation. Thirteen patients were totally continent, seven were fairly continent, and only two were poorly continent.
The functional results with this catheterizable umbilical low pressure intestinal pouch incorporating our new anti-reflux technique were satisfactory with better cosmesis.
在无法进行原位尿流改道时，对于膀胱癌患者进行膀胱全切术后构建可控性尿腹部造口术，美观、更好的功能和避免造口狭窄是重要问题。本研究旨在评估采用新的分体式回肠末段抗反流技术构建可控性带导管的脐部低压肠膀胱术的效果。
23 例患者在根治性膀胱切除术后，因无法进行原位重建而接受了带导管的脐部低压肠膀胱术，术中采用了新的黏膜肌层抗反流技术（分体式回肠末段）。平均手术时间为 210 分钟（根治性膀胱切除术 130 分钟，构建肠膀胱术 80 分钟）。术后平均随访 18 个月（6-30 个月）。
最常见的早期术后并发症是 9 例尿漏，其中 7 例保守治疗，2 例再次探查。8 例患者出现晚期术后并发症，其中 3 例发生造口狭窄，经反复扩张治疗成功。13 例患者完全可控，7 例基本可控，仅 2 例较差。
采用这种带导管的脐部低压肠膀胱术，结合我们新的抗反流技术，其功能结果令人满意，具有更好的美观效果。
