CUTANEOUS VESICOSTOMY IN THE YOUNG-CHILD - INDICATIONS AND RESULTS
CUTANEOUS VESICOSTOMY IN THE YOUNG-CHILD - INDICATIONS AND RESULTS
复制标题
DOI：
10.1016/0090-4295(93)90104-i
复制
发表时间：
1993-06-01
期刊：
影响因子：
2.1
通讯作者：
JOHNSON, HW
中科院分区：
文献类型：
--
作者：
KRAHN, CG;JOHNSON, HW
随着治疗幼儿下尿路病理的新方法的出现，皮肤膀胱造口术的作用可能正在发生变化。这促使我们对 10 年来在我们中心连续接受膀胱造口术治疗的 50 名患者进行了回顾。这些儿童在中位年龄 5.8 个月时接受了膀胱造口术改道，并且在随后关闭的 34 例膀胱造口术中，中位持续时间为 25 个月。我们的适应症与之前报道的系列一致，包括患有脑膜脊髓膨出、后尿道瓣膜或其他形式的先天性或后天性下尿路异常或功能障碍，以及膀胱输尿管反流、反复感染和/或肾脏恶化等复杂因素的患者。然而，我们还确定了一个主要群体——患有原发性膀胱输尿管反流的人——之前没有详细介绍。随访平均为三十八个月。超过 90% 的病例实现了上尿路的改善或稳定，并且这种趋势在膀胱造口闭合后仍在继续。此外，皮肤膀胱造口术使输尿管扩张正常化，减少反流程度以及随后输尿管逐渐变细和闭合时重新植入的需要。最后，尽管我们的造口修复率高达 20%，但我们仍在寻求改进的技术。
With newer methods of managing lower urinary tract pathology in the young child, the role of cutaneous vesicostomy may be changing. This prompted a review of 50 consecutive patients treated with initial vesicostomy at our center over a ten-year period. These children underwent vesicostomy diversion at a median age of 5.8 months and, of the 34 vesicostomies which have been subsequently closed, for a median duration of twenty-five months. Our indications agree with series reported previously and include patients with meningomyelocele, posterior urethral valves, or other forms of congenital or acquired lower urinary tract anomaly or dysfunction, along with complicating factors such as vesicoureteral reflux, recurrent infections, and/or renal deterioration. However, we also have identified a major group-those with primary gross vesicoureteral reflux-not previously included in detail. Follow-up averaged thirty-eight months. Improvement or stabilization of upper urinary tracts was achieved in over 90 percent of cases, and this trend continued after vesicostomy closure. As well, cutaneous vesicostomy allowed ureteral dilation to normalize, decreasing the degree of reflux and need for subsequent ureteral tapering and reimplantation at closure. Finally, though our stomal revision rate of 20 percent is high, modified techniques are being pursued.