Desgrandchamps F, Cariou G, Barthelemy Y, Boyer C, Teillac P, Le Duc A
Department of Urology, Saint-Louis Hospital, Paris, France.
J Urol. 1997 Sep;158(3 Pt 1):798-800. doi: 10.1097/00005392-199709000-00028.
We defined the mechanisms responsible for rupture of orthotopic, detubularized ileal bladder replacement.
We reviewed retrospectively the records of 5 cases of ileal neobladder rupture treated at our center between 1985 and 1995.
The interval to perforation varied from 3 to 60 months after surgery. The perforation site was typically the upper part of the right limb of the reservoir. We observed an acute episode of bladder over distension immediately before perforation in 2 cases and a chronic state of neobladder over distension in the 3 remaining cases. Bacterial infection was associated in 4 cases. Intraperitoneal adhesions were an associated mechanism for rupture in only 1 case. We found chronic ischemic changes weakening the bladder wall to be an additional factor for rupture in the 3 cases associated with chronic over distension.
Acute or chronic over distension of the neobladder is the main factor for spontaneous rupture of orthotopic detubularized ileal bladder replacement. Chronic ischemic changes of the bladder wall, possibly facilitated by detubularization and the variability of the mesenteric circulation, are additional factors that lead to perforation.
我们确定了原位去管化回肠膀胱替代物破裂的相关机制。
我们回顾性分析了1985年至1995年间在本中心接受治疗的5例回肠新膀胱破裂患者的记录。
穿孔发生在术后3至60个月不等。穿孔部位通常位于储尿囊右肢的上部。2例患者在穿孔前立即出现膀胱过度扩张的急性发作，其余3例患者存在新膀胱慢性过度扩张状态。4例患者伴有细菌感染。仅1例患者的破裂相关机制为腹腔粘连。我们发现，在与慢性过度扩张相关的3例患者中，慢性缺血性改变使膀胱壁变薄是导致破裂的另一个因素。
新膀胱的急性或慢性过度扩张是原位去管化回肠膀胱替代物自发性破裂的主要因素。膀胱壁的慢性缺血性改变，可能因去管化和肠系膜循环的变异性而加重，是导致穿孔的额外因素。
