Ahyai S A, Sayedahmed K, Engel O, Chun F, Dahlem R, Fisch M
Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Deutschland.
Urologe A. 2012 Jul;51(7):937-46. doi: 10.1007/s00120-012-2907-5.
In the vast majority of cases the terminal ileum is used for incontinent or continent bladder substitution. However, in irradiated patients the use of ileum segments or the ileocecal reservoir is associated with an increased risk of early and late complications. For this reason these patients should be treated with a transverse conduit or pouch as the method of choice if urinary diversion is indicated. The superior outcome of this high urinary diversion is due to the use of non-irradiated segments of the colon and ureter. The lack of experience in large bowel surgery by today's urologists should be compensated by training or referral of these high risk patients to a specialized center.
在绝大多数情况下,回肠末端用于构建可控或不可控膀胱替代物。然而,对于接受过放疗的患者,使用回肠段或回盲部储尿囊会增加早期和晚期并发症的风险。因此,如果需要进行尿流改道,这些患者应以横结肠导管或肠袋作为首选治疗方法。这种高位尿流改道效果较好的原因在于使用了未受照射的结肠段和输尿管段。当今泌尿外科医生在大肠手术方面经验不足的问题,应通过培训或将这些高危患者转诊至专科中心来加以弥补。