Mitrofanoff可控性尿流改道术治疗复杂神经源性膀胱1例并文献复习  

Mitrofanoff controlled urinary diversion for complex neurogenic bladder:a case report and literature review

作　　者：王继鑫 宋鸿文 王玉杰[1] 木拉提·热夏提[1] 王文光[1] WANG Jixin;SONG Hongwen;WANGYujie;MULATI Rexiati;WANG Wenguang(The First Affiliated Hospital of Xinjiang Medical University/Xinjiang Clinical Medical Research Center of Urogenital Diseases,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院/新疆泌尿男生殖系疾病临床医学研究中心,新疆乌鲁木齐830054

出　　处：《现代泌尿外科杂志》2022年第8期666-669,共4页Journal of Modern Urology

摘　　要：目的报告1例接受Mitrofanoff可控性尿流改道术治疗的复杂神经源性膀胱病例并结合文献探讨该疾病外科治疗要点。方法患者21岁,女性,临床诊断为神经源性膀胱;脊髓脊膜膨出术后;右侧上尿路积水;右侧膀胱输尿管返流;膀胱挛缩;真性尿失禁;泌尿道感染;先天性直肠阴道瘘;双足内翻畸形。采用分期手术治疗,Ⅰ期“输尿管膀胱再植,Mitrofanoff可控性尿流改道术”、Ⅱ期和Ⅲ期分别完成“直肠阴道瘘修补术”与“结肠造口回纳术”。结果自Ⅰ期手术后随访14个月,疗效满意。患者术后无严重并发症发生,每天自我导尿4~5次,每次导尿300~450 mL,无插管困难,肾功能正常,无电解质紊乱,B超提示右侧上尿路积水消失,储尿囊造影检查提示右侧输尿管无返流,膀胱容量达到500 mL。结论Mitrofanoff可控性尿流改道术是泌尿外科临床中治疗成人复杂神经源性膀胱可选手术方法。Objective To report a case of complex neurogenic bladder treated by Mitrofanoff controllable urinary diversion and to discuss the main points of surgical treatment of the disease.Methods A 21-year-old female was clinically diagnosed as neurogenic bladder.After surgry on meningocele,right upper urinary tract hydrops,right vesicoureteral reflux,bla-dder contracture,true urinary incontinence,urinary tract infection,congenital rectovaginal fistula and bipedal varus deformity were observed.The patient was treated with staging operation,including ureterovesical replantation and Mitrofanoff controlled urinary diversion,rectovaginal fistula repair and colostomy in stageⅠ,stageⅡand stageⅢ,respectively.Results The patient was followed up for 14 months after the first stage operation and the curative effect was satisfactory.There were no serious complications after operation.Self-catheterization was conducted 4 or 5 times a day,300~450 mL each time,with no difficulty in intubation.The renal function was nomal and no electrolyte disorder was observed.B-ultrasound showed disappearance of hydronephrosis in the right upper urinary tract,allantography showed no reflux in the right ureter and bladder capacity reached 500 mL.Conclusion Mitrofanoff controllable urinary diversion is an alternative method for the treatment of complex neurogenic bladder in adults in urology.

关 键 词：Mitrofanoff通道 神经源性膀胱尿失禁 尿流改道 阑尾 

分 类 号：R694.5[医药卫生—泌尿科学]