Stenzl A, Klutke C G, Golomb J, Raz S
Division of Urology, University of California School of Medicine, Los Angeles.
J Urol. 1990 Mar;143(3):607-11. doi: 10.1016/s0022-5347(17)40039-5.
One of the major limitations of continent intestinal reservoirs currently in use is failure of the efferent continence mechanisms. Unsatisfactory results have been reported in the literature in up to 40% of cases. While progress has been made toward better continence in urinary diversions, evolution of the actual continence mechanisms has been along two rather distinct paths: those with a valve mechanism placed inside the pouch (either by intussusception or surgical insertion), and those with the valve outside to the pouch (by imbrication of an externally located ileal segment). A canine experimental model was used to investigate a type of intraluminal continence mechanism and to compare it to an extraluminal imbricated ileocecal valve. In eight mongrel dogs a reservoir was made out of ascending and transverse colon with two different valve mechanisms--one intraluminal and one extraluminal--connected via separate stomas to the skin. Radiographic, sonographic, endoscopic and urodynamic studies of the pouch and its outlets were performed. Results showed that, in contrast to the extraluminal valve, continence in the intraluminal valve was volume dependent. The valve closing pressure of the intraluminal continence mechanism increased far beyond the values of the extraluminal valve (50.38 vs. 30.12 cm. H2O) at maximum pouch filling. Leakage of the intraluminal valve was observed at significantly higher pouch volumes than in the extraluminal valve (348 cc vs. 215 cc). In view of these results, the volume dependent intraluminal valve mechanism appears superior to an extraluminal type, especially at higher pouch volumes.
目前使用的可控性回肠贮袋的主要局限性之一是传出道控尿机制失效。文献报道高达40%的病例结果不尽人意。虽然在改善尿流改道的控尿方面已取得进展，但实际控尿机制的发展主要沿着两条截然不同的路径：一种是在贮袋内设置瓣膜机制（通过肠套叠或手术植入），另一种是在贮袋外设置瓣膜（通过外置回肠段的叠瓦状缝合）。采用犬实验模型研究一种腔内控尿机制，并将其与腔外叠瓦状回盲瓣进行比较。在8只杂种犬中，用升结肠和横结肠制作贮袋，采用两种不同的瓣膜机制——一种腔内瓣膜和一种腔外瓣膜——通过单独的造口与皮肤相连。对贮袋及其出口进行了放射学、超声学、内镜和尿动力学研究。结果表明，与腔外瓣膜相比，腔内瓣膜的控尿能力依赖于容量。在贮袋最大充盈时，腔内控尿机制的瓣膜关闭压力远高于腔外瓣膜（50.38 vs. 30.12 cmH₂O）。腔内瓣膜渗漏时的贮袋容量明显高于腔外瓣膜（348 cc vs. 215 cc）。鉴于这些结果，依赖容量的腔内瓣膜机制似乎优于腔外类型，尤其是在贮袋容量较大时。
