Chen K K, Chang L S, Chen M T, Huang J K, Yin J H, Lin S N
Department of Surgery, National Yang-Ming Medical College, Taiwan, Republic of China.
Urology. 1990 Apr;35(4):317-20. doi: 10.1016/0090-4295(90)80154-f.
Kock continent ileal reservoir for urinary diversion was performed in 53 patients with invasive bladder cancer (52) or neurogenic bladder (1). The postoperative follow-up period was from six to thirty-nine months. The clinical results showed no metabolic disturbance of blood electrolytes or acidity. Prolapse of efferent nipple valve developed in 4 patients (7.6%); and 2 underwent revisional surgery with a good result. Another 4 patients (7.6%) suffered from poor continence and relatively frequent catheterization to empty the pouch was necessary to prevent urine leakage through the stoma. Urodynamic study of the Kock pouch in these 4 patients showed a short functional nipple valve length and small pouch capacity. The other 45 patients (84.8%) had good continence. Urodynamic study of the pouch in 20 patients showed low pressure (mean of 13.3 cm H2O) in the pouch and high pressure (mean of 72.1 cm H2O) at the efferent nipple valve. Three patients had unilateral hydronephrosis in the follow-up intravenous urography. Corrective surgery for stenosis at the right ureteroileal anastomosis was done in 1 patient with normalization of the upper urinary tract afterward. The other 2 patients were managed by close observation for the mild hydronephrosis. Symptomatic bacteriuria developed in only 3 patients (5.7%) and responded well to antibiotic management. Reservoirography demonstrated no reflux into the upper urinary tract in all the follow-up patients. There was no significant change of the renal function at twenty-four months after operation detected by radionuclide (131I-Hippuran) renal functional study. All patients were satisfied with Kock urinary diversion.
对53例浸润性膀胱癌患者（52例）或神经源性膀胱患者（1例）实施了用于尿流改道的Kock回肠大陆膀胱术。术后随访期为6至39个月。临床结果显示血液电解质或酸碱度无代谢紊乱。4例患者（7.6%）出现输出乳头瓣脱垂；其中2例接受了修复手术，效果良好。另外4例患者（7.6%）控尿不佳，需要较频繁地导尿以排空贮尿囊，防止尿液通过造口漏出。对这4例患者的Kock贮尿囊进行尿动力学研究显示，功能性乳头瓣长度较短，贮尿囊容量较小。其他45例患者（84.8%）控尿良好。对20例患者的贮尿囊进行尿动力学研究显示，贮尿囊内压力较低（平均13.3 cm H₂O），输出乳头瓣处压力较高（平均72.1 cm H₂O）。3例患者在随访静脉肾盂造影检查中出现单侧肾积水。1例右侧输尿管回肠吻合口狭窄患者接受了矫正手术，术后上尿路恢复正常。另外2例轻度肾积水患者通过密切观察进行处理。仅3例患者（5.7%）出现有症状性菌尿，对抗生素治疗反应良好。所有随访患者的贮尿囊造影均未显示有尿液反流至上尿路。放射性核素（¹³¹I-马尿酸）肾功能研究显示，术后24个月肾功能无明显变化。所有患者对Kock尿流改道术均满意。
