Nieh P T, Althausen A F, Dretler S P
J Urol. 1978 Oct;120(4):402-6. doi: 10.1016/s0022-5347(17)57199-2.
Disappointing long-term experience with the ureterosigmoidostomy and ileal loop diversion has prompted our use of a staged ureterocolocolostomy in 3 adults with a good prognosis. Creation of a non-refluxing colon conduit was followed by conduit take-down and end-to-side colocolostomy 4 to 8 months later, when satisfactory loop function was documented (that is absence of reflux, obstruction and infection). Followup has shown stable renal function and electrolyte balance, as well as urinary/fecal continence. The staged ureterocolocolostomy, as opposed to the primary ureterosigmoidostomy, allows the partially obstructed urinary tract to decompress isolated from the fecal stream, may be used with established pyelonephritis, permits confirmation of the non-refluxing nature of the ureterocolic anastomosis prior to colocolostomy and may have a lower incidence of electrolyte imbalance. The staged procedure is contraindicated in patients with a poor prognosis, previously irradiated rectosigmoid, fecal incontinence or poor anal sphincter tone, inflammatory large bowel disease, inadequate ureteral length and strong family history of colon cancer.
输尿管乙状结肠吻合术和回肠袢转流术令人失望的长期疗效促使我们对3例预后良好的成人患者采用分期输尿管结肠造口术。先构建一个抗反流的结肠通道，4至8个月后，在证实通道功能良好（即无反流、梗阻和感染）时，进行通道拆除和端端结肠结肠吻合术。随访结果显示肾功能和电解质平衡稳定，同时保持了尿便自控。与一期输尿管乙状结肠吻合术不同，分期输尿管结肠造口术可使部分梗阻的尿路与粪流隔离进行减压，可用于已确诊的肾盂肾炎，在结肠结肠吻合术前可确认输尿管结肠吻合口无反流特性，且电解质失衡的发生率可能较低。该分期手术不适用于预后不良、先前接受过直肠乙状结肠放疗、大便失禁或肛门括约肌张力差、炎症性大肠疾病、输尿管长度不足以及有结肠癌家族史的患者。
