Montie J E, Pontes J E, Powell I J
Section of Urology, University of Michigan, Ann Arbor, USA.
Urology. 1996 Apr;47(4):476-81. doi: 10.1016/S0090-4295(99)80480-4.
Confidence has increased in the use of an orthotopic reservoir to the urethra after a cystoprostatectomy for bladder cancer; however, many surgeons would welcome a method to simplify the operative procedure. The availability of absorbable staples on a GIA stapler allows study of the incorporation of stapling procedures into formation of a reservoir. Because of the success of hand-sewn W-configured ileal reservoirs, we initiated a Phase II study to evaluate absorbable staples in formation of a W-configured reservoir. We now present an expanded contemporary series comparing a W-stapled ileal neobladder with hand-sewn ileal (Studer) or hand-sewn ileocolic (Le Bag) reservoirs.
Forty-five selected patients underwent orthotopic urinary diversion after cystoprostatectomy for bladder cancer (n = 42) or prostate cancer (n = 3) using one of the three methods of reservoir construction. There were 43 men and 2 women. The evaluation included a urodynamic evaluation and a questionnaire sent to patients inquiring about urinary function.
Most patients did well with the W-stapled ileal reservoir but 6 of 19 evaluable patients had unsatisfactory reservoir characteristics. Three patients needed an augmentation cystoplasty and 3 had higher pressure, smaller volume reservoirs. Reservoir function appeared to be consistently more favorable in patients with either of the hand-sewn reservoirs using an ileal or ileocolic segment.
Although the W-stapled ileal reservoir is safe and allows reservoir formation quickly, the inconsistencies of the results discourage its use in the particular configuration described. Failure of the reservoir to distend could be a function of reservoir design, areas of ischemia in the reservoir, or reaction to staple material. Absorbable staples on the GIA instrument may work satisfactorily for formation of an ileocolic reservoir for continent cutaneous diversion. However, the W-configured orthotopic reservoir as constructed using absorbable staples in this study is inferior to a hand-sewn ileal or ileocolic neobladder.
对于膀胱癌行膀胱前列腺切除术后使用原位尿流改道贮尿囊，人们的信心有所增强；然而，许多外科医生希望有一种方法能简化手术操作。GIA吻合器上可吸收吻合钉的出现，使得研究吻合钉技术在贮尿囊构建中的应用成为可能。鉴于手工缝合W形回肠贮尿囊取得了成功，我们开展了一项II期研究，以评估可吸收吻合钉在构建W形贮尿囊中的应用。我们现在展示一个扩大的当代系列研究，比较用吻合钉构建的W形回肠新膀胱与手工缝合的回肠（Studer式）或回结肠（Le Bag式）贮尿囊。
45例经选择的患者在因膀胱癌（n = 42）或前列腺癌（n = 3）行膀胱前列腺切除术后，采用三种贮尿囊构建方法之一进行原位尿流改道。其中男性43例，女性2例。评估包括尿动力学评估以及向患者发送的询问排尿功能的问卷。
大多数采用吻合钉构建W形回肠贮尿囊的患者情况良好，但19例可评估患者中有6例贮尿囊特性不理想。3例患者需要行膀胱扩大术，3例患者的贮尿囊压力较高、容量较小。使用回肠或回结肠段的手工缝合贮尿囊的患者，其贮尿囊功能似乎始终更优。
尽管吻合钉构建的W形回肠贮尿囊是安全的，且能快速形成贮尿囊，但结果的不一致性使其不宜用于所述的特定构型。贮尿囊不能扩张可能是贮尿囊设计、贮尿囊缺血区域或对吻合钉材料反应的结果。GIA器械上的可吸收吻合钉可能适用于构建可控性皮肤造口尿流改道的回结肠贮尿囊。然而，本研究中用可吸收吻合钉构建的W形原位贮尿囊不如手工缝合的回肠或回结肠新膀胱。
