Alcini E, Racioppi M, D'Addessi A, Alcini A, Menchinelli P, Grassetti F, Destito A, Sasso F, Giustacchini M
Universita Cattolica del Sacre Cuoro, Rome, Italy.
Br J Urol. 1997 Mar;79(3):333-8. doi: 10.1046/j.1464-410x.1997.03265.x.
To evaluate the results from the long-term follow-up of ileocaeco-urethrostomy with multiple transverse taeniamyotomies for bladder replacement.
Since 1987, 60 male patients have undergone bladder replacement using a technique of ileocaeco-urethrostomy with multiple transverse taeniamyotomies. Avoiding detubularization, sectioning the caecal taeniae improved reservoir morphology and reduced internal pressures and wall tension, limiting the potential complications of the operation.
All patients achieved diurnal continence with socially acceptable intervals between micturitions. Immediately after the operation, the nocturnal continence rate was good (79% of patients with a follow up < 3 years), reaching 86% after > 3 years. After 5 years, the reservoir capacity remained within the physiological range (mean volume 469 mL) with a mean maximum internal pressure of 47.6 cmH2O, while the mean post-micturition residual volume was 28 mL; no patient needs to use self-catheterization. Given the short intestinal length used, no metabolic clinical problems have occurred.
The concept of using the caecum arose from physiological and anatomical assumptions, i.e. receptive relaxation, the presence of taeniae and ileocaecal sphincter. Taeniamyotomies can achieve the same goals as detubularization, i.e. a reduction of wall tension and internal pressure and a near-spherical shape, but, in contrast, by leaving the circular muscle intact, they allow a good basal tone to be maintained thus obtaining optimal emptying and avoiding deterioration of the reservoir.
评估采用带多处横行肠肌切开术的回盲部尿道造口术进行膀胱替代的长期随访结果。
自1987年以来，60例男性患者采用带多处横行肠肌切开术的回盲部尿道造口术进行膀胱替代。避免去管化，切开盲肠带可改善储尿囊形态，降低内部压力和壁张力，限制手术的潜在并发症。
所有患者日间均能控制排尿，排尿间隔时间在社会可接受范围内。术后即刻，夜间控尿率良好（随访<3年的患者中79%），3年后达到86%。5年后，储尿囊容量保持在生理范围内（平均容积469 mL），平均最大内部压力为47.6 cmH₂O，而平均排尿后残余尿量为28 mL；无患者需要进行自我导尿。鉴于使用的肠段较短，未出现代谢方面的临床问题。
使用盲肠的理念源于生理和解剖学假设，即容受性舒张、肠带和回盲括约肌的存在。肠肌切开术可实现与去管化相同的目标，即降低壁张力和内部压力以及形成近似球形，但与之不同的是，通过保留环形肌完整，可维持良好的基础张力，从而实现最佳排空并避免储尿囊恶化。
