Hendren W H, Hendren R B
Department of Surgery, Children's Hospital, Boston, Massachusetts 02115.
J Urol. 1990 Aug;144(2 Pt 2):445-53; discussion 460. doi: 10.1016/s0022-5347(17)39486-7.
From 1977 to 1989 bladder augmentation was performed in 56 male and 73 female patients from 1 to 35 years old (average age 12.7 years). In 59 cases augmentation was performed as part of an undiversion operation. Indications for augmentation included neurogenic bladder, severely scarred bladder from prior operations, noncompliant bladder after previous treatment of severe urethral valves, small bladder in former exstrophy patients, epispadias with a small bladder, cloacal exstrophy, and small, noncompliant bladder after therapy for cancer, trauma, cloaca and miscellaneous conditions. We used 145 bowel segments, since 16 patients had 2 bowel segments. Segments included cecum in 65 cases, sigmoid in 46, small bowel in 24, stomach in 4 and left colon in 1. The most common complication was stones. Detubularized bowel for augmentation of small noncompliant bladders allows functional reconstruction in a wide range of urological disorders that were formerly treated by diversion. Reconstruction is possible in many previously diverted patients if bladder augmentation is used.
1977年至1989年期间，对56例男性和73例女性患者进行了膀胱扩大术，患者年龄在1至35岁之间（平均年龄12.7岁）。在59例病例中，膀胱扩大术作为去转流手术的一部分进行。膀胱扩大术的适应证包括神经源性膀胱、既往手术导致的严重瘢痕化膀胱、严重尿道瓣膜既往治疗后顺应性差的膀胱、原膀胱外翻患者的小膀胱、伴有小膀胱的尿道上裂、泄殖腔外翻以及癌症、创伤、泄殖腔和其他杂症治疗后的小的、顺应性差的膀胱。我们使用了145段肠管，因为有16例患者使用了2段肠管。其中65例使用盲肠段，46例使用乙状结肠段，24例使用小肠段，4例使用胃段，1例使用左结肠段。最常见的并发症是结石。去管化肠管用于扩大顺应性差的小膀胱，可在多种以前通过转流治疗的泌尿系统疾病中实现功能重建。如果采用膀胱扩大术，许多以前接受过转流手术的患者也有可能进行重建。
