Dagen J E, Sanford E J, Rohner T J
J Urol. 1980 Apr;123(4):585-7. doi: 10.1016/s0022-5347(17)56031-0.
The non-refluxing colon conduit has been offered as a superior alternative to the ileal conduit for long-term supravesical urinary diversion. The main advantage would seem to be that the upper tracts can be protected by the formation of a ureterocolic anastomosis without reflux, thereby preventing the deterioration associated with ileal conduits, which is presumably secondary to reflux and ascending infection. Although a colon operation is potentially more hazardous than a small bowel operation the short-term complication rates are not significantly different. We report 2 cases of stenosis of the ureterocolic anastomosis to emphasize that this serious complication continues to be a potential problem with any procedure of this type. With long-term followup its present incidence in 8 to 10 per cent of the patients may exceed the incidence of conduits with reflux. In our 2 cases severe stenosis of the ureter within the tunnel was encountered at reoperation. Techniques that may help prevent stenosis include preservation of periureteral adventitia, careful formation and closure of the submucosal tunnel, forming an anastomosis free of tension and tapering the ureters, when necessary, adequately but not excessively. Correction of this complication may require lysis of surrounding adhesions, a ureterocolic anastomosis with reflux, transureteroureterostomy, transureteropyelostomy, replacement of the ureter with small bowel or nephroureterectomy.
非反流性结肠导管已被视为长期膀胱上尿路改道的回肠导管的一种更优替代方案。其主要优势似乎在于，通过形成无反流的输尿管结肠吻合术可保护上尿路，从而防止与回肠导管相关的恶化，这种恶化可能继发于反流和上行性感染。尽管结肠手术可能比小肠手术更具风险，但短期并发症发生率并无显著差异。我们报告2例输尿管结肠吻合口狭窄病例，以强调这种严重并发症仍是此类任何手术的潜在问题。经长期随访，其目前在8%至10%的患者中的发生率可能超过有反流的导管的发生率。在我们的2例病例中，再次手术时发现隧道内输尿管严重狭窄。可能有助于预防狭窄的技术包括保留输尿管外膜、小心形成和关闭黏膜下隧道、形成无张力的吻合口以及必要时适当但不过度地使输尿管逐渐变细。纠正这种并发症可能需要松解周围粘连、进行有反流的输尿管结肠吻合术、输尿管输尿管吻合术、输尿管肾盂吻合术、用小肠替代输尿管或肾输尿管切除术。
