Figueroa T E, Sabogal L, Helal M, Lockhart J L
Department of Surgery, University of South Florida Health Sciences Center, H. Lee Moffitt Cancer and Research, Institute, Tampa General Hospital.
J Urol. 1994 Jul;152(1):73-5. doi: 10.1016/s0022-5347(17)32820-3.
Ten patients with a urethra that could not be catheterized and with absent appendixes underwent neobladder construction using an ileal segment fashioned to serve as the anti-incontinence mechanism. The latter was tapered and reimplanted following the guidelines of the Mitrofanoff procedure. Urinary reservoirs were constructed from detubularized segments of right colon, sigmoid colon and composite gastro-ileal combinations. Followup ranged from 9 to 21 months (mean 14.5). All patients presently catheterize the reservoir satisfactorily and are free of urinary leakage. Three patients (30%) experienced initial catheterization difficulties: 2 required endoscopic procedures and insertion of a stent, and 1 with stomal stenosis was successfully treated with a Y-V stoma plasty. One patient (10%) required a repeat ileal segment reimplantation due to urinary incontinence. The higher reoperation rate and the increased surgical complexity of this procedure compared with reconstructions using the ileocecal valve as part of the anti-incontinence mechanism make this operation a less attractive alternative in the creation of a continent urinary reservoir. However, with comprehension of the need for careful and detailed surgical technique in its creation, the tapered and reimplanted ileal segment is a successful choice as an alternative for the creation of an abdominal wall stoma when the appendix is unavailable.
10例无法插入导尿管且阑尾缺如的患者接受了新膀胱构建术，采用一段回肠制作抗尿失禁机制。按照米氏手术的指导原则，将回肠末端做成锥形并重新植入。尿囊由右半结肠、乙状结肠去管化节段以及胃回肠复合结构构建而成。随访时间为9至21个月（平均14.5个月）。目前所有患者均能顺利导尿，无尿漏发生。3例患者（30%）最初出现导尿困难：2例需要内镜操作并置入支架，1例因造口狭窄经Y-V造口成形术成功治疗。1例患者（10%）因尿失禁需要再次进行回肠段重新植入。与使用回盲瓣作为抗尿失禁机制的重建术相比，该手术的再手术率较高且手术复杂性增加，这使得该手术在构建可控性尿囊时成为一种吸引力较小的选择。然而，由于认识到在构建过程中需要仔细且详细的手术技术，当阑尾不可用时，做成锥形并重新植入的回肠段是创建腹壁造口的一种成功替代选择。
