Bradshaw Catherine J, Gray Robert, Downer Angela, Hitchcock Rowena
Department of Paediatric Surgery, Oxford Radcliffe NHS Trust, Oxford Children's Hospital, Headley Way, Oxford, OX3 9DU, UK.
Department of Urology, Oxford Radcliffe NHS Trust, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK.
J Pediatr Urol. 2014 Feb;10(1):80-7. doi: 10.1016/j.jpurol.2013.06.008. Epub 2013 Jul 27.
Over recent years the button vesicostomy has become an alternative management option in children with poor bladder emptying, when clean intermittent catheterisation (CIC) cannot be initiated for reasons of age, sensation, or urethral anatomy. This study reviews recent experience of this technique and evaluates its use.
Retrospective review of patients who had a button vesicostomy to permit bladder drainage between 1998 and 2011.
Thirty children underwent button vesicostomy insertion aged between 4 days and 16 years. Indications were neuropathic bladders (n = 15), congenital hypotonic bladders (n = 6), functional bladder disorders (n = 5), and post-obstruction bladders (n = 4). The median length of use was 11 months; however, 7 patients still have the button in situ. Minor complications (n = 12) included transient leakage, wound infection, and overgranulation. Major complications included 2 UTIs, 1 device failure, and 2 significant leaks, requiring revision of the tract and removal of the button.
The button vesicostomy is a suitable and safe technique for use in the short- and medium-term. The procedure has minimal morbidity and therefore is acceptable to families. It has a wide scope, including patients with a neuropathic bladder as an alternative to CIC and where temporary drainage is required until bladder function can recover.
近年来，对于膀胱排空功能不佳的儿童，当因年龄、感觉或尿道解剖结构等原因无法开始进行清洁间歇性导尿（CIC）时，纽扣式膀胱造瘘术已成为一种替代治疗选择。本研究回顾了该技术的近期经验并评估了其应用情况。
对1998年至2011年间接受纽扣式膀胱造瘘术以实现膀胱引流的患者进行回顾性研究。
30名年龄在4天至16岁之间的儿童接受了纽扣式膀胱造瘘术。适应证包括神经源性膀胱（n = 15）、先天性低张性膀胱（n = 6）、功能性膀胱障碍（n = 5）和梗阻后膀胱（n = 4）。使用的中位时长为11个月；然而，7名患者的纽扣仍在原位。轻微并发症（n = 12）包括短暂渗漏、伤口感染和过度肉芽组织增生。主要并发症包括2例尿路感染、1例装置故障和2例严重渗漏，需要对通道进行修复并取出纽扣。
纽扣式膀胱造瘘术在短期和中期是一种合适且安全的技术。该手术的发病率极低，因此家庭可以接受。它适用范围广泛，包括神经源性膀胱患者，可作为CIC的替代方法，以及在膀胱功能恢复之前需要临时引流的情况。
