Landa Juárez Sergio, Fernández Ana María Castillo, Castro Niccolo Ruiz, De La Cruz Yañez Hermilo, Hernández Carlos García
1 Pediatric Urology Department, Pediatric Hospital CMN SXXI, Mexican Social Security Institute , Mexico City, Mexico .
J Laparoendosc Adv Surg Tech A. 2014 Jun;24(6):422-7. doi: 10.1089/lap.2013.0290. Epub 2014 Jan 29.
To describe a laparoscopic surgical technique for ureterocystoplasty in pediatric patients with the Mitrofanoff procedure.
The procedure was performed in 4 patients (2 females and 2 males), 8-11 years old (average, 9.5 years), with a history of myelomeningocele and secondary neurogenic bladder. The patients were evaluated before the surgery with renal ultrasound, voiding cystourethrography, and renal scintigraphy. All subjects reported left hydronephrosis with severe dilatation of ureter and the collector system, left megaureter with grade V vesicoureteral reflux, and left functional exclusion, with right renal normal function. The urodynamic investigations revealed low bladder size and bladder leak point pressure (BLPP) above 40 cm H2O. The laparoscopic ureterocystoplasty augmentation procedure and the Mitrofanoff procedure with the proximal ureter were performed in these patients. Complications and outcomes were recorded and compared with those of the postoperative urodynamic test.
The 2-4 years of follow-up of the patients and its urodynamic postoperative evaluation reported at least 75% of the capacity according to their age, compliance that varied between 15 to 20 mL/cm H2O, and a BLPP of less than 40 cm H2O. This last parameter is considered of low risk to damage the upper urinary tract. There was no leaking of urine by the stoma over the 4 hours of catheterization.
Even though enterocystoplasty is the gold standard to increase the capacity of the neurogenic bladder, it has an elevated morbidity. So the use of a dilative ureter to increase bladder size and create a Mitrofanoff stoma in patients with neurogenic bladder, pop-off phenomenon, and renal ipsilateral atrophy could be considered by the laparoscopic approach.
描述一种用于患有米氏术式的小儿患者输尿管膀胱扩大术的腹腔镜手术技术。
该手术在4例患者（2例女性和2例男性）中进行，年龄8至11岁（平均9.5岁），有脊髓脊膜膨出和继发性神经源性膀胱病史。术前对患者进行了肾脏超声、排尿性膀胱尿道造影和肾闪烁显像评估。所有受试者均报告有左肾积水，输尿管和集合系统严重扩张，左巨输尿管伴V级膀胱输尿管反流，以及左肾功能排除，右肾功能正常。尿动力学检查显示膀胱容量小，膀胱漏点压（BLPP）高于40 cm H₂O。对这些患者进行了腹腔镜输尿管膀胱扩大术及近端输尿管米氏术式。记录并发症和结果，并与术后尿动力学检查结果进行比较。
对患者进行2至4年的随访及其术后尿动力学评估显示，根据年龄至少有75%的容量，顺应性在15至20 mL/cm H₂O之间变化，且BLPP小于40 cm H₂O。最后这个参数被认为对上尿路造成损伤的风险较低。在导尿4小时期间造口无尿液渗漏。
尽管肠膀胱扩大术是增加神经源性膀胱容量的金标准，但它的发病率较高。因此，对于患有神经源性膀胱、排尿异常现象和同侧肾萎缩的患者，可考虑通过腹腔镜方法使用扩张的输尿管来增加膀胱容量并创建米氏造口。
