Milanović D, Perović S, Krstić Z, Sremcević D, Vukadinović V
University Children's Hospital, Belgrade.
Srp Arh Celok Lek. 1996;124 Suppl 1:81-5.
Detrusor tunnelling is an extravesical surgical procedure of ureteral reimplantation. It is surely the least traumatic method of surgical correction of vesico-ureteral reflux because antireflux mechanism is achieved with minimal detrusor muscle dissection. This procedure simplifies implantation of dilated ureters, double ureters as well as the ureters shortened by previous antireflux surgical procedures. Ureteral tapering is unnecessary. One hundred and forty detrusor tunnelling uretero-cysto-neostomies in 102 patients have been performed in the University Children's Hospital between January 1990 and September 1994. The youngest patient was 1 month old and the eldest was 15 years (mean age 6.8 years). Indications for surgical treatment were primary (45.0%) and secondary (26.4%) megaureter as well as grade IV & V (international classification) vesico-ureteral reflux (28.6%). Follow up was 1-40 months (mean 26 months). Excellent postoperative results were achieved in 130 detrusor tunnelling uretero-cysto-neostomies, i.e. more than 90% of patients. Complication rate was 7.1% (6 patients-10 ureteral units) and about one third were classified as major-postoperative relapses or stenosis or minor-intraoperative mucosal perforation, hematuria, parahiatal diverticulum, spontaneous proximal migration of ureteral double J stent-about two thirds.
逼尿肌隧道术是输尿管再植的一种膀胱外手术方法。它无疑是膀胱输尿管反流手术矫正中创伤最小的方法，因为抗反流机制是通过最少的逼尿肌解剖来实现的。该手术简化了扩张输尿管、双输尿管以及因先前抗反流手术而缩短的输尿管的植入。不需要输尿管变细。1990年1月至1994年9月期间，在大学儿童医院对102例患者进行了140例逼尿肌隧道输尿管膀胱新造口术。最年轻的患者1个月大，最年长的15岁（平均年龄6.8岁）。手术治疗的适应证为原发性（45.0%）和继发性（26.4%）巨输尿管以及IV级和V级（国际分类）膀胱输尿管反流（28.6%）。随访1 - 40个月（平均26个月）。130例逼尿肌隧道输尿管膀胱新造口术取得了优异的术后效果，即超过90%的患者。并发症发生率为7.1%（6例患者 - 10个输尿管单位），约三分之一被归类为主要并发症 - 术后复发或狭窄，或次要并发症 - 术中黏膜穿孔、血尿、食管旁憩室、输尿管双J支架自发近端移位 - 约三分之二。
