Canning D A, Gearhart J P, Peppas D S, Jeffs R D
Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, Maryland 21205.
J Urol. 1993 Jul;150(1):156-8. doi: 10.1016/s0022-5347(17)35421-6.
A modified technique of ureteroneocystostomy with bladder neck plasty was used in 36 of 75 patients undergoing staged repair of bladder exstrophy or epispadias between 1986 and 1992. This procedure entails mobilizing the ureter while preserving the trigonal hiatus as with the cross-trigonal technique. The distal ureteral segments are directed superiorly toward the bladder dome rather than across the mid line. Of 75 patients 36 underwent cephalotrigonal reimplantation and 39 had a conventional cross-trigonal reimplant. Continence rate was 77% in the patients who underwent cephalotrigonal reimplantation and 72% in those who had a cross-trigonal reimplant. No patient had ureteral obstruction or vesicoureteral reflux. The ureter in exstrophy patients enters the bladder from an inferior position within the true pelvis. Directing the ureter superiorly rather than across the mid line provides a more gradual course through the hiatus and submucosal tunnel. The cranial course of the distal ureter frees more of the trigone for use in the rolled segment of the bladder neck and provides more muscle area for the tube. This is especially important in the patient in whom the distance between the mid prostate and trigone is particularly short.
1986年至1992年间，75例接受膀胱外翻或尿道上裂分期修复的患者中，有36例采用了改良的输尿管膀胱吻合术并进行膀胱颈成形术。该手术需要像采用跨三角技术那样，在保留三角区裂孔的同时游离输尿管。输尿管远端段向上朝向膀胱顶部，而不是穿过中线。75例患者中，36例行头侧三角区再植术，39例行传统的跨三角区再植术。接受头侧三角区再植术的患者控尿率为77%，接受跨三角区再植术的患者控尿率为72%。没有患者出现输尿管梗阻或膀胱输尿管反流。膀胱外翻患者的输尿管从真骨盆内的较低位置进入膀胱。将输尿管向上而不是穿过中线引导，可使其通过裂孔和黏膜下隧道的路径更加平缓。输尿管远端的头侧走行释放出更多的三角区，用于膀胱颈的卷折段，并为管道提供更多的肌肉区域。这在前列腺中部与三角区之间距离特别短的患者中尤为重要。
