Skinner D G, Boyd S D, Lieskovsky G
J Urol. 1984 Dec;132(6):1101-7. doi: 10.1016/s0022-5347(17)50052-x.
From August 1982 through January 1984, 51 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 to prevent reflux and to ensure continence. Previous urinary diversion was by ureterosigmoidostomy in 3 patients, standard ileal conduit in 7 and suprapubic cystotomy in 1. A total of 39 patients underwent simultaneous anterior exenteration for pelvic malignancy. There was 1 postoperative death and early complications occurred in 10 patients. Of these 10 patients 4 required reoperation: 2 for drainage of a pelvic abscess, 1 for conversion to a standard ileal conduit and 1 for bleeding. Late complications occurred in only 8 patients: 5 required reoperation and revision of the continence valve mechanism, and 3 required hospitalization for brief episodes of pyelonephritis. The end result in 49 of 50 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 electrolytes have remained normal and hyperchloremic acidosis has been encountered in only 1 patient who had had compromised renal function preoperatively with hyperchloremic acidosis as a result of previous ureterosigmoidostomy. X-rays of the Kock pouch have shown evidence of reflux in only 1 patient, 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.
从1982年8月至1984年1月，51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，利用一段回肠创建一个可控性贮尿囊。一项重要的改进包括沿着贮尿囊的输入和输出肠袢切除8厘米宽的窄系膜带，以实现充分的回肠套叠，并进行固定以防止反流并确保控尿功能。之前3例患者通过输尿管乙状结肠吻合术进行尿流改道，7例采用标准回肠造瘘术，1例采用耻骨上膀胱切开术。共有39例患者因盆腔恶性肿瘤同时接受了前盆腔脏器清除术。术后有1例死亡，10例患者出现早期并发症。在这10例患者中，4例需要再次手术：2例因盆腔脓肿引流，1例因改为标准回肠造瘘术，1例因出血。仅8例患者出现晚期并发症：5例需要再次手术并修复控尿瓣膜机制，3例因肾盂肾炎短暂发作而需要住院治疗。50例患者中有49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。血清电解质保持正常，仅1例术前肾功能受损且因之前的输尿管乙状结肠吻合术存在高氯性酸中毒的患者出现了高氯性酸中毒。科克贮尿囊的X线检查仅在1例患者中显示有反流迹象，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情况有所改善。尽管这只是初步的，但该临床试验表明，对于之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贮尿囊可显著改善其生活质量。
