Reddy Mallikarjun N, Nerli Rajendra B, Patil Ranjeet A, Jali Sujata M
Department of Pediatrics, KLES Dr. Prabhakar Kore Hospital, Jawaharlal Nehru Medical College Campus, Belgaum, Karnataka, India.
Afr J Paediatr Surg. 2015 Apr-Jun;12(2):126-30. doi: 10.4103/0189-6725.160356.
In 1980, Mitrofanoff described the creation of an appendicovesicostomy for continent urinary diversion. This procedure greatly facilitates clean intermittent catheterisation in patients with neurogenic bladder. The purpose of our study was to determine the clinical efficacy of the laparoscopic Mitrofanoff catheterisable stoma for children and adolescents with spina bifida.
Review of hospital records revealed that 11 children with spina bifida underwent a laparoscopic Mitrofanoff procedure with at least 1-year of follow-up. A four-port transperitoneal laparoscopic approach was used to create a Mitrofanoff appendicovesicostomy. The child was followed-up in the urology clinic at 6 weeks, 3 months, 6 months, 1-year, and then semiannually after that. Questionnaires were administered to determine, from the children's perspective, the level of satisfaction with catheterisation and the psychosocial implications of catheterisation before and after the creation of the Mitrofanoff continent catheterisable stoma.
Of the 11 children, six were female, and five were male. The mean age at presentation to Paediatric urological services was 11 × 3.22 years. Overall the mean operative time was 144.09 × 17.00 min. Mean estimated blood loss was 37.36 × 11.44 cc. None of the cases needed conversion to open. Patient satisfaction with their catheterisation was measured at 2.18 × 0.98 preoperatively, Post-operatively, this improved to 4.27 × 0.46. Statistical analysis using paired t-test showed significance with P < 001.
Laparoscopic Mitrofanoff catheterisable stoma is feasible in children with spina bifida and is associated with reasonable outcome with early recovery, resumption of normal activities and excellent cosmesis.
1980年，米特罗法诺夫描述了用于可控性尿流改道的阑尾膀胱造口术的创建。该手术极大地便利了神经源性膀胱患者的清洁间歇性导尿。我们研究的目的是确定腹腔镜米特罗法诺夫可控性造口术对患有脊柱裂的儿童和青少年的临床疗效。
回顾医院记录发现，11例患有脊柱裂的儿童接受了腹腔镜米特罗法诺夫手术，并至少随访了1年。采用四孔经腹腹腔镜入路创建米特罗法诺夫阑尾膀胱造口术。患儿在泌尿外科门诊于术后6周、3个月、6个月、1年进行随访，之后每半年随访一次。发放问卷以从患儿角度确定在创建米特罗法诺夫可控性造口术前和术后对导尿的满意度以及导尿对心理社会的影响。
11例患儿中，6例为女性，5例为男性。向小儿泌尿外科就诊时的平均年龄为11±3.22岁。总体而言，平均手术时间为144.09±17.00分钟。平均估计失血量为37.36±11.44毫升。所有病例均无需转为开放手术。术前患儿对导尿的满意度评分为2.18±0.98，术后提高至4.27±0.46。采用配对t检验的统计分析显示差异有统计学意义，P<0.01。
腹腔镜米特罗法诺夫可控性造口术在患有脊柱裂的儿童中是可行的，且具有恢复早、能恢复正常活动和美容效果极佳等合理的结果。
