Millard R J, Wang Y
Department of Urology, Prince Henry Hospital, Sydney, New South Wales, Australia.
Aust N Z J Surg. 1996 Dec;66(12):826-9. doi: 10.1111/j.1445-2197.1996.tb00759.x.
Alternatives to cutaneous diversion have included continent urinary diversion and replacement cystoplasty. Five-year experience with continent diversion is reported.
Between 1989 and 1994, 29 patients underwent continent urinary diversion. Of these, 24 patients underwent Indiana pouch procedures and five patients had a Mitrofanoff-type procedure. All have now been followed up for at least 12 months.
The continence rate for the Indiana pouch group was 23/24 (96%) and the mean capacity was 648 mL (range 300-1400). There were nine (37.5%) early postoperative complications, only three of which (12.5%) required surgical revision. The late complication rate was 35.5% (7/22), and 18.2% (4/22) of the patients underwent re-operation. Stomal stenosis occurred in two patients in whom the stoma was situated in the right iliac fossa, whereas all 12 stomas sited at the umbilicus had no stomal problem. Four of the five patients having Mitrofanoff procedures were continent, but these patients had higher rates of early and late complications.
From this experience, the Indiana pouch urinary diversion appears to be superior to the Mitrofanoff procedure when continent diversion is indicated. An umbilical stoma site is optimal.
皮肤造口改道术的替代方法包括可控性尿流改道术和膀胱替代成形术。本文报告了可控性尿流改道术的五年经验。
1989年至1994年间，29例患者接受了可控性尿流改道术。其中，24例患者接受了印第安纳袋手术，5例患者接受了米氏术式。所有患者目前均已随访至少12个月。
印第安纳袋组的控尿率为23/24（96%），平均容量为648毫升（范围300-1400毫升）。术后早期并发症有9例（37.5%），其中仅3例（12.5%）需要手术修正。晚期并发症发生率为35.5%（7/22），18.2%（4/22）的患者接受了再次手术。造口位于右髂窝的2例患者发生了造口狭窄，而位于脐部的所有12个造口均无造口问题。接受米氏术式的5例患者中有4例控尿，但这些患者的早期和晚期并发症发生率较高。
根据本经验，当需要进行可控性尿流改道时，印第安纳袋尿流改道术似乎优于米氏术式。脐部造口位置最佳。
