Matsushima M, Boyd S D, Lieskovsky G, Skinner D G
Hinyokika Kiyo. 1986 Jul;32(7):955-67.
From July 1985 through January 1986, 43 patients underwent urinary diversion that included creation of a continent reservoir from an ileal segment, according to the method described originally by Kock. An important modification included removal of a narrow strip of mesentery for 8 cm along the afferent and efferent limbs of the pouch to allow adequate ileal intussusception and fixation of the nipple valves to prevent reflux and to ensure continence. A strip of PGA mesh serves as a collar to fix the afferent-efferent limb to the pouch once the intussusception technique has been accomplished. The use of a narrow Marlex strip allows fixation to the abdominal wall both lateral and medial to the stoma site (insert). This strip is important in preventing a parastomal hernia and helps fix the continence valve mechanism to the posterior abdominal wall. Previous urinary diversion was by ureterosigmoidostomy in 2 patients, standard ileal conduit in 8 and chronic dialysis after nephrectomy of solitary kidney and cystectomy in 1. A total of 32 patients underwent simultaneous anterior exenteration or radical cystectomy for pelvic malignancy. There were 4 postoperative deaths and early complications occurred in one patient. Late complications occurred in only 3 patients: they required reoperation and revision of the continence valve mechanism. The end result in 39 of 43 patients has been an overwhelming success. Patients perform self-catheterization every 4 to 6 hours during the day and once at night for volumes ranging up to 1,400 cc. Serum electolytes have remained normal in all patients. X-ray of the Kock pouch have shown no evidence of reflux, and all excretory urograms have demonstrated either normal upper tracts without obstruction or improvement in patients with preoperative hydronephrosis. Although preliminary, this clinical trial suggests that the quality of life for patients considered previously to be candidates for cutaneous diversion can be improved markedly by a modified Kock continent ileal reservoir. During the same time, 21 patients out of 278 patients who underwent creation of a Kock continent ileal urinary reservoir since August 1982, underwent revision of Kock pouch. Two of those required subsequent reoperation and revision of the continence valve mechanism. The end result in all patients has been an overwhelming success.
1985年7月至1986年1月，43例患者接受了尿流改道术，其中包括按照最初由科克描述的方法，用一段回肠构建可控性储尿囊。一项重要的改进包括沿着储尿囊的输入和输出肠袢切除8厘米长的窄系膜条，以实现充分的回肠套叠并固定乳头瓣，防止反流并确保控尿。一旦完成套叠技术，一条聚乙醇酸网片用作套环，将输入 - 输出肠袢固定到储尿囊上。使用窄的聚四氟乙烯条可将其固定在造口部位外侧和内侧的腹壁上（插图）。这条带子对于预防造口旁疝很重要，并有助于将控尿瓣膜机制固定到后腹壁。之前2例患者的尿流改道术采用输尿管乙状结肠吻合术，8例采用标准回肠导管术，1例在孤立肾肾切除和膀胱切除术后进行慢性透析。共有32例患者因盆腔恶性肿瘤同时接受了前盆腔脏器清除术或根治性膀胱切除术。术后有4例死亡，1例出现早期并发症。仅3例患者出现晚期并发症：他们需要再次手术并修复控尿瓣膜机制。43例患者中有39例最终取得了巨大成功。患者白天每4至6小时进行一次自我导尿，晚上进行一次，尿量可达1400毫升。所有患者的血清电解质均保持正常。科克储尿囊的X线检查未显示反流迹象，所有排泄性尿路造影均显示上尿路正常无梗阻，或术前有肾积水的患者病情有所改善。尽管这只是初步的，但这项临床试验表明，对于以前被认为适合行皮肤造口尿流改道的患者，改良的科克可控性回肠储尿囊可显著改善其生活质量。在同一时期，自1982年8月以来接受科克可控性回肠储尿囊构建手术的278例患者中有21例接受了科克储尿囊修复术。其中2例随后需要再次手术并修复控尿瓣膜机制。所有患者最终都取得了巨大成功。
