Long-term followup of augmentation enterocystoplasty and continent diversion in patients with benign disease
Long-term followup of augmentation enterocystoplasty and continent diversion in patients with benign disease
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DOI：
10.1097/01.ju.0000154891.40110.08
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发表时间：
2005-05-01
影响因子：
6.6
通讯作者：
Stahl, PJ
中科院分区：
文献类型：
--
作者：
Blaivas, JG;Weiss, JP;Stahl, PJ
目的：我们评估良性泌尿系疾病患者行肠膀胱成形术(AC)(有或无腹壁造口)或可控性尿流改道的长期结果。材料和方法：这是一项连续76例因良性泌尿系统疾病而接受AC(有或无腹壁造口)或可控性尿流改道的成人的回顾性研究。结果：76例患者(男18例，女58例)年龄19~80岁，平均49岁。术后随访1~19年，平均8.9年。术前诊断神经原性膀胱炎41例，逼尿肌功能亢进9例，间质性膀胱炎7例，终末期膀胱病7例，放射性膀胱炎3例，外翻3例，术后尿路梗阻3例，膀胱顺应性低3例。在71名可评价的患者中，49名(69%)认为自己痊愈了，14名(20%)认为自己有所改善，8名(11%)认为治疗失败。7例间质性膀胱炎患者治疗均失败。平均膀胱容量由166升至572ml，平均最大逼尿肌压力由53降至14 cm H2O。所有患者的血肌酐均有所改善或保持正常。5名患者出现持续性腹泻，需要间歇性抗痉挛药物，但无维生素B12缺乏、恶性贫血或吸收不良综合征。远期并发症：造口狭窄或尿失禁11例(42%)，新发膀胱结石2例(3%)，肾结石1例(1%)，复发膀胱结石6%。71例患者中5例(7%)发生肠梗阻，4例(6%)需行手术探查。结论：AC加尿流改道是治疗顽固性神经原性膀胱的一种安全有效的长期治疗方法，但可控性尿流改道术后的造口问题仍是并发症的主要原因。
Purpose: We evaluated long-term outcomes in patients undergoing augmentation enterocystoplasty (AC) (with or without an abdominal stoma) or continent urinary diversion in patients with benign urological disorders.Materials and Methods: This was a retrospective study of 76 consecutive adults who underwent AC (with or without an abdominal stoma) or continent urinary diversion because of benign urological conditions. The outcomes assessed were a patient satisfaction questionnaire, continence status, catheterization status, bladder capacity, bladder compliance, detrusor instability, maximum detrusor pressure, upper tract status, significant postoperative morbidity, need for reoperation, persistent diarrhea and vitamin B12 deficiency.Results: The 76 patients (18 men and 58 women) were 19 to 80 years old (mean age 49). Followup was 1 to 19 years (mean 8.9). Preoperative diagnoses were neurogenic bladder in 41 patients, refractory detrusor overactivity in 9, interstitial cystitis in 7, end stage bladder disease in 7, radiation cystitis in 3, exstrophy in 3, postoperative urethral obstruction in 3 and low bladder compliance in 3. A total of 50 patients underwent simple AC, 15 underwent AC with an abdominal stoma and 11 underwent continent supravesical diversion. Of the 71 evaluable patients 49 (69%) considered themselves cured, 14 (20%) considered themselves improved and 8 (11%) considered treatment to have failed. All 7 patients with interstitial cystitis had failed treatment. Mean bladder capacity increased from 166 to 572 ml and mean maximum detrusor pressure decreased from 53 to 14 cm H2O. Serum creatinine improved or remained normal in all patients. Five patients experienced persistent diarrhea requiring intermittent antispasmodics but none had vitamin B12 deficiency, pernicious anemia or malabsorption syndrome. Long-term complications were stomal stenosis or incontinence in 11 of 26 patients (42%) with stomas, de novo bladder and renal stones in 2 of 71 (3%) and 1 of 71 (1%), respectively, and recurrent bladder stones in 6%. Small bowel obstruction occurred in 5 of 71 patients (7%), requiring surgical exploration in 4 (6%).Conclusions: AC and urinary diversion provide a safe and effective long-term therapy in patients with refractory neurogenic bladder but stomal problems in patients with continent diversion continue to be a source of complications.