Gearhart J P, Albertsen P C, Marshall F F, Jeffs R D
J Urol. 1986 Aug;136(2):430-2. doi: 10.1016/s0022-5347(17)44893-2.
Since 1976, 23 children with bladder or cloacal exstrophy, meningomyelocele, sacral agenesis, the prune belly syndrome and noncompliant bladders associated with urethral valves or prior diversion underwent augmentation cystoplasty. Of these procedures 7 were combined with some type of urinary undiversion. Bowel segments used for augmentation included ileum alone in 10 patients, ileocecal segments in 4, a sigmoid patch in 8 and a hindgut patch in 1. An artificial urinary sphincter was placed at the time of bladder augmentation in 3 patients. There were no urinary fistulas or cases of urinary rediversion. Two patients required oral alkalizing agents as a result of persistent systemic acidosis. One patient required reoperation twice for ureteral obstruction, 1 had removal of the sphincter device secondary to erosion, 1 required reinforcement of the ileocecal valve owing to persistent reflux and 1 required reoperation for small bowel obstruction. Other complications included a superficial wound infection and 5 urinary tract infections, all of which were managed easily. Three patients were voiding and continent, 18 were dry with intermittent self-catheterization, 1 had giggle incontinence and 1 remained incontinent after sphincter removal. Augmentation cystoplasty appears to offer a reliable alternative to urinary diversion in the reconstructive management of children with small capacity bladders.
自1976年以来，23例患有膀胱外翻或泄殖腔外翻、脊髓脊膜膨出、骶骨发育不全、梅干腹综合征以及与尿道瓣膜或既往改道相关的顺应性差膀胱的患儿接受了膀胱扩大术。在这些手术中，7例合并了某种类型的尿流改道回原术。用于扩大膀胱的肠段包括：10例仅用回肠，4例用回盲段，8例用乙状结肠补片，1例用后肠补片。3例患者在膀胱扩大术时放置了人工尿道括约肌。未发生尿瘘或尿流改道回原的情况。2例患者因持续性全身酸中毒需要口服碱化剂。1例患者因输尿管梗阻需要再次手术2次，1例因括约肌装置侵蚀而取出，1例因持续性反流需要加强回盲瓣，1例因小肠梗阻需要再次手术。其他并发症包括1例表浅伤口感染和5例尿路感染，所有这些都很容易处理。3例患者能自主排尿且控尿，18例通过间歇性自我导尿保持干燥，1例有傻笑性尿失禁，1例在取出括约肌后仍失禁。在容量小的膀胱患儿的重建治疗中，膀胱扩大术似乎是尿流改道的一种可靠替代方法。
