Jeong Seong Jin, Oh Seung-June
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Int Neurourol J. 2020 Sep;24(3):200-210. doi: 10.5213/inj.2040120.060. Epub 2020 Sep 30.
Augmentation enterocystoplasty (AEC) is a surgical procedure in which the bladder is enlarged using an intestinal segment in patients with lower urinary tract dysfunction who fail to achieve satisfactory results with all conservative treatments. Currently, surgical materials and procedures, concomitant correction of upper urinary tract abnormalities, or bladder neck reconstruction may vary depending on the experience and preferences of the surgeons. AEC has been proven to be successful with respect to surgical goals, such as achieving urinary continence, improving quality of life, and preserving the upper urinary tract over the long term. The advantage of AEC over intravesical injection of botulinum toxin-a more recent and less invasive procedure-is that the prevention of upper urinary tract damage and the improvement of urinary incontinence are more reliably guaranteed, especially considering that these surgical effects are permanent. Compared to less invasive treatments, the quality of life of patients after surgery is also much higher, and AEC may be more cost-effective in the long run. Thus, in patients with neurogenic bladder, AEC is still the gold standard surgical procedure with strong evidence in support of its efficacy. In this article, the indications, surgical methods, possible complications, long-term follow-up, and current positioning of AEC in lower urinary tract dysfunction is discussed.
扩大性膀胱肠成形术（AEC）是一种外科手术，对于所有保守治疗均未取得满意效果的下尿路功能障碍患者，该手术使用一段肠管来扩大膀胱。目前，手术材料和操作、上尿路异常的同期矫正或膀胱颈重建可能因外科医生的经验和偏好而有所不同。AEC在实现尿失禁、改善生活质量以及长期保护上尿路等手术目标方面已被证明是成功的。与膀胱内注射肉毒杆菌毒素（一种更新的、侵入性较小的手术）相比，AEC的优势在于能更可靠地保证预防上尿路损伤和改善尿失禁，特别是考虑到这些手术效果是永久性的。与侵入性较小的治疗方法相比，术后患者的生活质量也更高，从长远来看，AEC可能更具成本效益。因此，在神经源性膀胱患者中，AEC仍然是有充分证据支持其疗效的金标准手术。本文讨论了AEC在下尿路功能障碍中的适应证、手术方法、可能的并发症、长期随访及当前定位。
