McRae P, Murray K H, Nurse D E, Stephenson T P, Mundy A R
Department of Urology, Royal Infirmary, Cardiff.
Br J Urol. 1987 Dec;60(6):523-5. doi: 10.1111/j.1464-410x.1987.tb05034.x.
Clam enterocystoplasty has proved to be the most effective treatment for severe detrusor instability resistant to conservative treatment (Bramble, 1982; Mundy and Stephenson, 1985). More recently it has become the procedure of choice in patients with neuropathic bladders with hyper-reflexia or severely impaired compliance, provided that the bladder is of reasonable size and that gross fibrosis and/or diverticular formation of the bladder wall has not occurred. Fifty-nine patients have undergone the clam procedure as part or all of their reconstruction in the past 4 years. Although uncontrolled incontinence was the commonest indication, impaired renal function was the indication in 14 patients and need for undiversion in seven. Currently all but four are voiding satisfactorily or are on intermittent self-catheterisation, though six have significant stress incontinence. The clam procedure is easier, quicker and as satisfactory as substitution cystoplasty in selected cases.
夹闭肠膀胱扩大术已被证明是治疗对保守治疗无效的严重逼尿肌不稳定的最有效方法（Bramble，1982年；Mundy和Stephenson，1985年）。最近，对于患有神经源性膀胱伴反射亢进或顺应性严重受损的患者，如果膀胱大小合理且膀胱壁未出现严重纤维化和/或憩室形成，该手术已成为首选。在过去4年中，有59例患者接受了夹闭手术作为其重建手术的一部分或全部。虽然无节制性尿失禁是最常见的适应症，但14例患者的适应症是肾功能受损，7例患者需要解除尿流改道。目前，除4例患者外，所有患者排尿情况均令人满意或采用间歇性自我导尿，不过有6例患者存在明显的压力性尿失禁。在某些病例中，夹闭手术比替代膀胱扩大术更简便、快捷且效果相当。
