Ahlering T E, Weinberg A C, Razor B
Department of Urology, University of Southern California School of Medicine.
J Urol. 1989 Nov;142(5):1193-6. doi: 10.1016/s0022-5347(17)39026-2.
Between July 1986 and July 1988, 55 urinary diversions were performed, including 18 ileal conduits, and 12 Kock and 25 Indiana pouch procedures. The different forms of urinary diversion were compared for patient selection, operative technical demands, postoperative complications, perioperative renal function and short-term followup, including rehospitalizations, revisions and pouch function. Patient selection was the same for the ileal conduit and Indiana pouch groups. Kock pouch patients were more highly selected for youth and health status. The operative technical demands of the ileal conduit and Indiana pouch were similar. The average operative time and blood loss for cystectomy and ileal conduit were 5 hours 27 minutes and 1,290 cc versus 5 hours 30 minutes and 1,201 cc for the Indiana pouch group. Postoperative complications and changes in renal function were similar among all 3 groups except for an increase in urinary anastomotic leaks in heavily irradiated ileal conduit patients. The ileal conduit patients required no rehospitalizations or revisions, the Indiana pouch group had 4 rehospitalizations and no revisions, and the Kock pouch group had 9 rehospitalizations and 3 revisions. The day and nighttime continence rate was 100% in the Indiana and Kock pouch groups. The Indiana pouch has similar technical demands as the ileal conduit, similar postoperative complications as the ileal conduit or Kock pouch, and functions well with a low revision rate. We conclude that the modified Indiana pouch can be accomplished safely and effectively in any patient requiring an ileal conduit.
1986年7月至1988年7月期间，共进行了55例尿路改道手术，包括18例回肠膀胱术、12例Kock术式和25例印第安纳袋术式。对不同形式的尿路改道在患者选择、手术技术要求、术后并发症、围手术期肾功能及短期随访（包括再次住院、修复手术和尿袋功能）方面进行了比较。回肠膀胱术组和印第安纳袋术组的患者选择标准相同。Kock袋术的患者在年轻和健康状况方面选择更为严格。回肠膀胱术和印第安纳袋术的手术技术要求相似。膀胱切除术加回肠膀胱术的平均手术时间和失血量分别为5小时27分钟和1290毫升，而印第安纳袋术组为5小时30分钟和1201毫升。除了接受大量放疗的回肠膀胱术患者尿路吻合口漏增加外，所有3组的术后并发症和肾功能变化相似。回肠膀胱术患者无需再次住院或进行修复手术，印第安纳袋术组有4例再次住院且无修复手术，Kock袋术组有9例再次住院和3例修复手术。印第安纳袋术组和Kock袋术组白天和夜间的控尿率均为100%。印第安纳袋术与回肠膀胱术的技术要求相似，与回肠膀胱术或Kock袋术的术后并发症相似，且功能良好，修复率低。我们得出结论，改良的印第安纳袋术对于任何需要行回肠膀胱术的患者都能安全有效地完成。
