Gerharz E W, Köhl U, Weingärtner K, Melekos M D, Bonfig R, Riedmiller H
Department of Urology, Philipps-University Medical School, Marburg, Germany.
J Urol. 1997 Nov;158(5):1709-13. doi: 10.1016/s0022-5347(01)64105-3.
We compared the incidence, treatment and outcome of complications related to different continence mechanisms in a single institutional series of continent urinary diversions using an ileocecal reservoir.
From November 1990 through October 1996 in 193 consecutive cases an ileocecal pouch (Mainz I) was used as a low pressure, high capacity reservoir. A submucosally embedded in situ appendix was used in 96 patients (mean age 57.2 years, mean followup 35.6 months) and an ileal intussusception valve was used in 106 (mean age 58.4, mean followup 33.1 months). Without exception the stoma was placed in the umbilicus.
In 172 patients (85.2%) no stoma related complication was observed. In 17 patients (17.7%) with appendix stoma 23 reinterventions were performed, for appendico-umbilical stenosis in all but 2 cases (15.6%), occurring after a mean of 20.4 months. Two complete appendix necroses required replacement by ileal nipple. Stomal stenoses could be corrected as minor outpatient procedures. In 13 of 106 patients (12.3%) with intussuscepted ileal nipple a second operation became necessary after a mean interval of 9.6 months (partial/complete necrosis of nipple in 4 cases, dislocation of nipple from ileocecal valve in 3, detachment from fascia in 4 and stomal stenosis in 2). Whereas no calculi were observed in the appendix group, stones had to be removed from 3 patients (2.8%) with ileal nipple.
In situ appendix and intussuscepted ileal valve techniques are satisfactory in providing ileocecal reservoir continence. Besides the known advantages of the appendix as the primary reconstructive approach, the treatment of subsequent complications is simple. Therefore, whenever an appropriate appendix is encountered it should be the intestinal segment of choice in forming a continence mechanism.
我们在一个使用回盲部贮尿囊的单一机构连续性尿流改道系列研究中，比较了与不同控尿机制相关并发症的发生率、治疗方法及结局。
1990年11月至1996年10月，连续193例患者采用回盲部袋（美因茨I型）作为低压、大容量贮尿囊。96例患者（平均年龄57.2岁，平均随访35.6个月）使用黏膜下原位阑尾，106例患者（平均年龄58.4岁，平均随访33.1个月）使用回肠套叠瓣。无一例外，造口均位于脐部。
172例患者（85.2%）未观察到与造口相关的并发症。17例（17.7%）采用阑尾造口的患者进行了23次再次手术，除2例（15.6%）外，均因阑尾-脐部狭窄，平均发生在20.4个月后。2例阑尾完全坏死需要用回肠乳头替代。造口狭窄可作为小门诊手术进行纠正。106例采用套叠回肠乳头的患者中有13例（12.3%）在平均9.6个月的间隔后需要再次手术（4例乳头部分/完全坏死，3例乳头从回盲瓣脱位，4例从筋膜分离，2例造口狭窄）。阑尾组未观察到结石，而3例（2.8%）采用回肠乳头的患者需要取出结石。
原位阑尾和套叠回肠瓣技术在提供回盲部贮尿囊控尿方面令人满意。除了阑尾作为主要重建方法的已知优点外，后续并发症的治疗也很简单。因此，只要遇到合适的阑尾，它就应该是形成控尿机制时首选的肠段。
