Epplen R, Pfister D, Heidenreich A
Klinik und Poliklinik für Urologie, Universitätsklinikum Aachen, Pauwelsstraße 30, Aachen, Germany.
Urologe A. 2011 Nov;50(11):1431-4. doi: 10.1007/s00120-011-2631-6.
Intestinal neobladder fistula is one of the rare complications following radical cystectomy which is described in about 1.5-2% of all patients. We report on 2 of 267 consecutive patients who underwent radical cystectomy with an orthotopic neobladder who developed such a fistula. Both patients presented initially with recurrent urinary tract infections, fever and chills. In both cases the final diagnosis was made after oral intake of poppy seeds. Imaging studies of choice to identify the anatomical localisation of the fistula and to exclude accompanying intra-abdominal fluid collections were made by computed tomography and magnetic resonance imaging. The treatment of choice consists of surgical excision of the fistula, double-layer closure of the neobladder and small bowel resection or double-layer closure depending on the size of the fistula. A conservative approach only seems to be justified in patients with significant comorbidities or very small fistulas without systemic symptoms.
肠道新膀胱瘘是根治性膀胱切除术后罕见的并发症之一，在所有患者中的发生率约为1.5% - 2%。我们报告了267例连续接受原位新膀胱根治性膀胱切除术的患者中有2例发生了这种瘘。两名患者最初均表现为反复的尿路感染、发热和寒战。在这两例中，最终诊断都是在口服罂粟籽后做出的。用于确定瘘的解剖定位并排除伴随的腹腔内积液的首选影像学检查是计算机断层扫描和磁共振成像。治疗的选择包括手术切除瘘管、新膀胱双层缝合以及根据瘘管大小进行小肠切除或双层缝合。仅在有严重合并症或瘘管非常小且无全身症状的患者中，保守治疗似乎才是合理的。
