Heij H A, Ekkelkamp S, Moorman-Voestermans C G, Vos A
Kinderchirurgisch Centrum Amsterdam, Emma Kinderziekenhuis/Kinder AMC and Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.
Pediatr Surg Int. 1997 Apr;12(4):286-8. doi: 10.1007/BF01372151.
Treatment of children with severe impairment of bladder function requires a large-volume, low-pressure reservoir combined with a continent, easily catheterizable valve. The Mitrofanoff principle (MP) appears to meet these requirements. Between 1986 and 1993, the MP was applied in 15 children (4 girls) aged 4 to 14 years. The primary diagnosis was bladder exstrophy in 8 (2 girls), neuropathic bladder in 3 (2 girls), urethral valves in 2, and rhabdomyosarcoma (RMS) in 2. In 10 patients bladder augmentation with an intestinal patch was performed in addition to a Mitrofanoff procedure; in 5 a neobladder and continent appendicostomy were made. One boy with RMS died of distant metastases with a well-functioning appendicostomy and adequate renal function. At 2 to 9 years follow-up of the other 14 patients, 12 have a good result defined as: (1) adequate reservoir capacity; (2) continence; (3) normal renal function; and (4) no hydronephrosis. In 1 exstrophy patient with pre-existing impairment of renal function, further deterioration necessitated frequent catheterization and additional medical treatment. In 1 boy with fulgurated urethral valves, spontaneous micturition became subsequently possible, allowing closure of his appendicovesicostomy. Complications occurred in 10 patients, necessitating reintervention in 7. The MP in combination with the creation of an adequate reservoir gives good results in children with severe impairment of bladder function. Careful attention should be given to patient education regarding emptying of the reservoir. Long-term follow-up of renal function is mandatory.
治疗膀胱功能严重受损的儿童需要一个大容量、低压的储尿囊，并结合一个可控、易于导尿的瓣膜。米特罗法诺夫原理（MP）似乎满足这些要求。1986年至1993年期间，MP应用于15名年龄在4至14岁的儿童（4名女孩）。主要诊断为膀胱外翻8例（2名女孩）、神经源性膀胱3例（2名女孩）、尿道瓣膜2例、横纹肌肉瘤（RMS）2例。10例患者除了进行米特罗法诺夫手术外，还进行了肠片膀胱扩大术；5例患者进行了新膀胱和可控阑尾造口术。1例患有RMS的男孩因远处转移死亡，其阑尾造口功能良好且肾功能正常。在对其他14例患者进行2至9年的随访中，12例结果良好，定义为：（1）储尿囊容量充足；（2）控尿；（3）肾功能正常；（4）无肾积水。1例膀胱外翻患者术前已有肾功能损害，肾功能进一步恶化，需要频繁导尿和额外的药物治疗。1例患有电灼尿道瓣膜的男孩随后能够自主排尿，其阑尾膀胱造口得以关闭。10例患者出现并发症，7例需要再次干预。MP结合创建足够的储尿囊，对于膀胱功能严重受损的儿童能取得良好效果。应特别注意对患者进行储尿囊排空方面的教育。必须对肾功能进行长期随访。
