Gosalbez R, Gousse A E
Department of Urology, University of Miami, Florida, USA.
J Urol. 1998 Feb;159(2):530-4. doi: 10.1016/s0022-5347(01)63978-8.
Patients undergoing reconstruction of short or severely dilated aperistaltic ureters are at significant risk for mechanical or functional obstruction and reflux, particularly when the ureters are being reimplanted into gastric or intestinal segments. For this problem we describe a simple handsewn, "stapleless" antireflux ileal nipple, which serves as a useful bridge between a short ureter and the bladder or reservoir.
A total of 12 patients, 4 to 42 years old (mean age 19), 9 with severely dilated and 3 with short ureters have received the stapleless antireflux ileal nipple as part of various reconstructive efforts. Briefly, a 12 to 15 cm. segment of ileum is isolated and the mesentery is stripped from the middle 8 cm. of the isolated segment, preserving the blood supply to the proximal and distal 2 cm. of ileum. Intussusception is created and maintained with multiple (5 to 7) circumferential rows of 4 to 6 interrupted seromuscular stitches of 3-zero silk.
Mean followup is 27.5 months (range 6 to 60). Upper tract dilatation has stabilized or improved in all patients, deteriorating temporarily in 1 who had distal nipple stenosis. All patients underwent followup video urodynamic studies, which demonstrated no reflux. Nipple related complications included nipple stenosis in 1 patient and dessusception in another. Both complications were corrected without sequelae. Ureteroileal stenosis or stone formation has not occurred.
The stapleless antireflux ileal nipple is safe and reliable in preventing reflux. It is a versatile adjunct to urinary reconstruction in patients with short or severely dilated, aperistaltic ureters in whom the alternative of a tapered reimplantation into a segment of bowel or stomach poses a significant complication threat.
接受短段或严重扩张的无蠕动输尿管重建术的患者，发生机械性或功能性梗阻及反流的风险很高，尤其是当输尿管重新植入胃或肠段时。针对这一问题，我们描述了一种简单的手工缝合、“无吻合钉”抗反流回肠乳头，它可作为短输尿管与膀胱或贮尿囊之间的有用桥梁。
共有12例患者，年龄4至42岁（平均年龄19岁），其中9例输尿管严重扩张，3例输尿管短，他们接受了无吻合钉抗反流回肠乳头术，作为各种重建手术的一部分。简要来说，分离出一段12至15厘米的回肠，从分离段中间8厘米处剥离肠系膜，保留回肠近端和远端各2厘米的血供。通过多排（5至7排）4至6针3-0丝线间断浆肌层缝合形成并维持肠套叠。
平均随访27.5个月（范围6至60个月）。所有患者上尿路扩张均已稳定或改善，1例远端乳头狭窄患者暂时出现恶化。所有患者均接受了随访视频尿动力学检查，结果显示无反流。与乳头相关的并发症包括1例乳头狭窄和另1例肠套叠复位。两种并发症均得到纠正，无后遗症。未发生输尿管回肠狭窄或结石形成。
无吻合钉抗反流回肠乳头在预防反流方面安全可靠。对于短段或严重扩张的无蠕动输尿管患者，在将输尿管锥形重新植入肠段或胃段会带来严重并发症风险的情况下，它是一种多功能的尿路重建辅助手段。
