肠膀胱扩大加阑尾输出道在小儿可控性尿流改道手术中的应用  

Application of augmented enterocystoplasty and continent urinary diversion by using the appendix in pediatric patients

作　　者：田军[1] 孙宁[1] 张潍平[1] 白继武[1] 谢向辉[1] 李明磊[1] 宋宏程[1] 李宁[1] 黄澄如[1] 

机构地区：[1]首都医科大学附属北京儿童医院外科泌尿组,100045

出　　处：《中华泌尿外科杂志》2008年第7期478-481,共4页Chinese Journal of Urology

摘　　要：目的 探讨肠膀胱扩大加阑尾输出道手术在小儿可控性尿流改道中的应用效果。方法 小儿肠膀胱扩大加阑尾输出道可控性尿流改道手术患儿22例。男12例，女10例。年龄5～14岁，平均8岁。脊髓脊膜膨出术后致神经性膀胱11例，男童陈旧性骨盆骨折致后尿道断裂、反复手术后尿道狭窄伴尿失禁2例，女童陈旧性骨盆骨折致尿道狭窄合并尿道阴道瘘反复手术修补失败3例，尿生殖窦畸形伴高位肛门闭锁术后完全性尿失禁2例，膀胱外翻和尿道上裂膀胱颈重建术后尿失禁2例，男童后尿道瓣膜2例。肾、输尿管扩张积水17例28侧，其中15例24侧伴Ⅱ～V级膀胱输尿管反流，术中行输尿管与贮尿囊再吻合术。患儿均自阑尾输出道间歇清洁导尿。术前与术后行尿动力学检查、IVu、B超、排尿性膀胱尿道造影及血尿素氮、肌酐和生化电解质等检查。比较手术前后膀胱及上尿路功能的变化，评估手术疗效。结果 术后随访1．5～6．o年，平均3．6年。22例阑尾输出道均无漏尿。2例术后早期阑尾输出道皮肤造口狭窄，扩张1～3个月后插管顺利。2例仍自尿道漏尿，其中1例手术缝合膀胱颈口后治愈，l例进行盆底肌肉训练。术前和术后贮尿期末膀胱内压力分别为（45．47±14．15）、（16．24±5．25）cmH2O（1cmH2O=0．098kPa），膀胱最大测压容积分别为（65．5±43．5）、（337．0±189．50）ml，残余尿量（56．0±22．5）ml，导尿后完全排空，术前最大尿道闭合压力和术后最大输出道闭合压力分别为（35．24±14．46）、（78．40±20．15）cmH2O，膀胱顺应性分别为（8．25±7．33）、（26．75±8．45）ml／cmH2O，手术前后比较差异均有统计学意义（P〈0．01）。肾、输尿管积水较术前无加重，膀胱输尿管未见反流。结论 肠膀胱扩大加阑尾输出道可控性尿流改道手术是治疗小儿膀胱和尿道解剖及功能Objective To evaluate the long-term functional results, complications and patient＇s satisfaction level in patients performed augmented enterocystoplasty and continent urinary diversion using the appendix. Methods From 1999 to 2005, there were 22 children （12 males and 10 females） underwent augmented enterocystoplasty and continent urinary diversion using the appendix. Surgical results were reviewed retrospectively. There were 11 cases with bladder and urethra dysfunction attributed to neurogenic bladder, 2 cases with complex genitourinary malformation associated with an imperforated anus, 2 cases with exstrophy epispadias complex , 2 cases with posterior urethral valves, 3 cases with failed urethrovaginal fistula repair and 2 epispadias cases with post failure of Young-Dees-Leadbetter bladder neck reconstruction. Upper urinary tract dilatation and hydroureteronephrosis were found in 17 cases （28 units）, including grade II-V vesicoureteral reflux in 15 children （24 units）. Simultaneous procedures included ureteral reimplantation in 15 cases and bladder neck closure in 14 cases. The appendix was used as the catheterizable conduit placed in the right lower abdomen and clean intermittent catheterization was performed in all patients. Outcomes were assessed by urodynamic study, IVU, ultrasound, voiding cystourethrography, BUN, Cr and electrolyte test. Results Mean follow-up was 3.6 years, ranging from 1.5-6 years. Complications included stomal stenosis requiring dilatation in 2 cases and leakage in 2 cases without bladder neck closure and 1 case required surgical revision. All patients achieved excellent stomal continence. No metabolic acidosis and bladder stone was noted. Upper urinary tract impairment had not worsened in all patients. Conclusion Augmented enterocystoplasty and continent urinary diversion using the appendix are associated with high continence, compliance and satisfaction rate and a low complication rate in the treatment of pediatric patients with disorders related to bladder and urethra

关 键 词：尿流改道 可控性 膀胱 阑尾 

分 类 号：R726[医药卫生—儿科]