Mickute Zita, Chen Yi-An, Som Robin, Malata Charles M
University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom.
Ann Plast Surg. 2012 Mar;68(3):295-9. doi: 10.1097/SAP.0b013e318212f3f9.
The aim of this study was to describe the indications, surgical technique and outcomes of abdominoplasty as a novel tool for revising complicated urostomies.
Four patients (3 female, 1 male; mean body mass index = 32 kg/m; mean age = 56 years) who underwent abdominoplasty for urostomy revision 2007-2009 were identified. Ileal conduits had been performed following ablative or diversion surgery for cervical carcinoma, bladder carcinoma, interstitial cystitis, and neuropathic bladder. A postal questionnaire was used to establish pre- and postabdominoplasty stoma function.
Patients were referred to the reconstructive team with problems fitting their urostomy-appliance leading to urinary leakage, skin irritation, and social embarrassment. Uro-abdominoplasty indications included multiple abdominal scars (n = 2), large abdominal apron (n = 4), and deep skin creases (n = 2). Three patients had undergone previous failed urostomy repositioning or peristomal liposuction. The joint plastic surgical-urological operations lasted a mean of 3 hours, with no major postoperative complications. Patients were discharged 8 days later. Of 4 patients, 3 reported improved appliance fitting and reduced urinary leakage (>50%) and the remaining patient had intermittent leakage due to a persistent abdominal fold superiorly, and has since undergone reverse abdominoplasty. Two patients complained of long-term lower abdominal numbness, but all 4 were satisfied with the aesthetic improvement.
Abdominoplasty has been successfully used in our center for the purpose of improving urostomy dysfunction of intractable mechanical leakage by creating a flatter surface for appliance fitting. Uro-abdominoplasty widens the reconstructive repertoire of plastic surgeons and can be considered in those who have exhausted conservative or simpler surgical solutions.
本研究旨在描述腹壁成形术作为一种用于修复复杂尿路造口术的新工具的适应症、手术技术及效果。
确定了2007年至2009年期间因尿路造口术修复而接受腹壁成形术的4例患者（3例女性，1例男性；平均体重指数=32kg/m；平均年龄=56岁）。回肠代膀胱术是在宫颈癌、膀胱癌、间质性膀胱炎和神经源性膀胱的根治性手术或改道手术后进行的。采用邮寄问卷的方式来确定腹壁成形术前和术后的造口功能。
患者因尿路造口装置佩戴问题被转诊至重建团队，这些问题导致尿液渗漏、皮肤刺激和社交尴尬。尿路腹壁成形术的适应症包括多处腹部瘢痕（n=2）、巨大腹壁围裙样赘肉（n=4）和深部皮肤褶皱（n=2）。3例患者此前曾有尿路造口重新定位失败或造口周围抽脂术失败的经历。整形外科与泌尿外科联合手术平均持续3小时，无重大术后并发症。患者8天后出院。4例患者中，3例报告装置佩戴改善，尿液渗漏减少（>50%），其余1例患者因上腹部持续存在腹壁褶皱而有间歇性渗漏，此后接受了反向腹壁成形术。2例患者抱怨长期下腹部麻木，但4例患者均对美学改善感到满意。
在我们中心，腹壁成形术已成功用于通过创造更平坦的表面以适配装置来改善顽固性机械性渗漏的尿路造口功能障碍。尿路腹壁成形术拓宽了整形外科医生的重建手术范围，对于那些已用尽保守或更简单手术解决方案的患者可考虑采用。
