Augmentation enterocystoplasty
Augmentation enterocystoplasty
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DOI：
10.1016/j.anuro.2004.08.001
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发表时间：
2004-12-01
影响因子：
--
通讯作者：
Le Normand, L
中科院分区：
文献类型：
--
作者：
Rigaud, J;Le Normand, L
肠膀胱扩大成形术是指一种切除肠段以将其缝合到膀胱上的技术。该技术适用于膀胱容量和/或顺应性降低的情况，以及保守治疗失败的情况。其目标是改善患者的排尿舒适度，但最重要的是确保上尿路的长期保护。所有肠段均可使用，但回肠是首选段。选择的消化段必须去管，以更好地减少其蠕动收缩，并获得低压储尿。保留逼尿肌的双瓣膀胱术通常用于肠膀胱扩大术。然而，如果逼尿肌纤维化和增厚，应考虑上三角区膀胱。切除消化段并去管，然后在切口水平将其作为补片缝合到膀胱上。在这种手术后，超过90%的患者报告生活质量显著改善。在90%以上的患者中获得了夜间膀胱功能，而91%至100%的患者报告了日间膀胱功能。可能会观察到长期并发症，如慢性感染伴无症状性血尿（70%的病例），无需任何治疗。在最初的两年内，肠道粘液发育后形成结石的风险为10%至15%。肠膀胱成形术穿孔的发生率估计为5%至13%，这是一种非常严重且危及生命的并发症。同样，在1%的病例中，5至10年后可能会观察到肠膀胱成形术癌症的风险。(C)2004年，Elsevier SAS。图斯所有权保留。
Augmentation enterocystoplasty refers to a technique that consists in removing a bowel segment in order to suture it onto the bladder. This technique is indicated in case of reduced bladder capacity and/or compliance, in case of failure of conservative treatments. The goal is to improve the patient's urination comfort, but above all to ensure long-term protection of the upper urinary tract. All bowel segments may be utilized but the ileum is the segment of choice. The selected digestive segment must be detubulized in order to better decrease its peristaltic contractions and obtain low-pressure urine storage. Bi-valving the bladder while preserving the detrusor usually performs augmentation enterocystoplasty. However, in case of very fibrous and thickened detrusor, a supra-trigonal cystectomy should be considered. The digestive segment is removed and detubulized, then it is sutured on to the bladder as a patch at the incision level. Following such surgery, over 90% of the patients report significantly improved quality of life. Nocturnal bladder competence is obtained in more than 90% of the patients, while 91 to 100% report diurnal bladder competence. Long-term complications may be observed, such as chronic infections with asymptomatic bacteruria (70% of the cases) not necessitating any treatment. Within the two first years, there is a 10% to 15% risk for stone formation following intestinal mucus development. Enterocystoplasty perforation may occur at a frequency estimated to range from 5 to 13%, which is a very serious and life-threatening complication. Similarly, a risk of enterocystoplasty cancer may be observed after five to ten years, in 1% of the cases. (C) 2004 Elsevier SAS. Tous droits reserves.