可控性阑尾输出道尿流改道术在小儿下尿路功能障碍性疾病治疗中的应用效果  

Application of Mitrofanoff procedure in pediatric lower urinary tract dysfunction

作　　者：付凯 伏雯 贾炜 刘国昌 Fu Kai;Fu Wen;Jia Wei;Liu Guochang(Department of Pediatric Urological,Guangzhou Women and Childrens＇Medical Center,Guangzhou 510120,China)

机构地区：[1]广州市妇女儿童医疗中心小儿泌尿外科,510120

出　　处：《中华泌尿外科杂志》2018年第11期835-838,共4页Chinese Journal of Urology

摘　　要：目的探讨可控性阑尾输出道尿流改道术在小儿下尿路功能障碍性疾病治疗中的应用效果。方法回顾性分析2014年1月至2018年1月收治的9例行可控性阑尾输出道尿流改道术患儿的临床资料。男2例，女7例。年龄4-14岁，平均7．3岁。1例为完全性膀胱外翻，4例为神经源性膀胱，2例为车祸伤致尿道断裂，2例为膀胱横纹肌肉瘤。9例均在全麻下行可控性阑尾输出道尿流改道术，均采用阑尾作为输出道，阑尾长度不足者取部分盲肠壁卷管缝合以延长输出道。3例采用原膀胱作为储尿囊，4例行回肠膀胱扩大术，2例行回肠代膀胱术，阑尾远端包埋至储尿囊黏膜下起抗反流作用。5例输出道开口于脐部，4例输出道开口于麦氏点附近。结果本组9例手术均顺利完成，术中无均无大出血，以及呼吸、循环衰竭等并发症发生。手术时间176-210min，平均190inin。术中出血量20-35ml，平均22ml。术后10-14d拔除伤口引流管，术后3周拔除输出道支架管。术后随访15-50个月。B超检查示1例采用原膀胱作为储尿囊的神经源性膀胱患儿的膀胱容量较大（250m1），余8例术后膀胱容量为80-120ml。4例神经源性膀胱患儿术后仍有一定程度反流及双肾积水，较术前未加重；余5例无反流发生。术后9例经指导后均可熟练进行插管导尿，无瘘口狭窄发生。瘘口处均无漏尿。2例女性患儿在腹压升高时有尿液自原尿道口流出，于术后6个月行膀胱颈封闭术。结论可控性阑尾输出道尿流改道术可应用于神经源性膀胱、尿道断裂及膀胱恶性肿瘤等终末期下尿路功能障碍患儿的治疗，可使患儿间歇性导尿操作更方便。Objective To discuss the treatment effect with Mitrofanoff procedure in lower urinary tract of pediatric patients. Methods 9 patients conducted Mitrofanoff procedure from January 2014 to January 2018 in our center were analyzed retrospectively. There were 2 boys and 7 girls, age from 4 to 14 years old （7.3 years old in average）. 1 child was diagnosed as bladder exstrophy,4 children were neurogenic bladder,2 children were bladder tumor and the other 2 were urethral trauma. All patients were conducted Mitrofanoff procedure under general anesthesia, used appendix as the conduit, 3 patients used their original bladder as reservoir, bladder augmentation was employed in 4 patients and ileal neobladder was employed in 2 patients to construct reservoir. The distal of appendix was inserted into submucosal of reservoior and the proximal end was connected to the umbilical or lower abdominal wall. Results The operations were all successfully completed without sever complications,the time spent was 176 -210 rain, 190 min in average, hemorrhage amount 20 -35 ml. Patients were followed up 15 to 50 months,the bladder capacity is 80 to 120 ml. Hydronephrosis was improved compared with pre-operative condition. 4 children diagnosed with neurogenic bladder still suffered vesical ureteral reflux. All patients can conduct clean intermittent catheterization without difficulty. There was no leakage of urine from the stoma, while 2 patients showed leakage of urine from urethra when exercising, so we closed the bladder neck 6 month later. Conclusion Mitrofanoff procedure can be implied in children with end-staged lower urinary tract dysfunction due to nerogenic bladder, bladder tumor, bladder exstrophy, which makes intermittent catheterization become more convenient.

关 键 词：下尿路功能障碍 阑尾输出道 尿流改道 储尿囊 

分 类 号：R726.9[医药卫生—儿科]