[The new uretero-ileal anastomosis technique in Hautmann ileal neobladder].
[The new uretero-ileal anastomosis technique in Hautmann ileal neobladder].
复制标题
Hautmann回肠新膀胱输尿管回肠吻合新技术[J].
DOI：
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发表时间：
2001
期刊：
影响因子：
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通讯作者：
R. Gnann
中科院分区：
文献类型：
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作者：
M. Soulie;R. D. de Petriconi;J. Gschwend;R. Hautmann;R. Gnann
客观化
Hautmann新膀胱术是目前国内外应用最广泛的膀胱术式之一。采用Camey-le Duc技术，输尿管回肠狭窄率估计为11%。为了改善术后并发症，提出了一种新的吻合术。
材料和方法
在新膀胱术的W的两端准备两个5~10 cm的回肠段，以容纳大量溅起的输尿管。吻合术直接在回肠切除缘，严格的腹膜后位置进行。1996年12月至1998年12月，对89名患者进行了这项技术，其中包括19名女性。对166个肾单位(RU)进行术前肾脏超声检查，分别于术后1、3、6个月复查，每6个月复查一次。每月进行尿液培养，连续6个月。
结果
术前RU扩张(II、III级)13例(7.8%)。术后平均随访5.8+/-7.6个月，无吻合口继发狭窄。166个RU中，129个正常，13个术前扩张改善，24个RU术后轻度扩张(I级)。术后逆行膀胱造影示回输尿管返流2例。唯一的并发症是1个月时的急性肾盂肾炎(1.1%)。6个月后，90%的尿液培养无菌。
结论
用“双烟囱”技术改良输尿管回肠吻合术，通过将两个输尿管放置在一个解剖位置，而不是折叠或扭转，从而实现无张力。保留输尿管血供有助于降低并发症发生率和减少狭窄风险。然而，这项技术需要通过对结果的分析来验证，并进行更长时间的随访。
OBJECTIVE
Hautmann neobladder is one of the most widely bladder replacement techniques in the two sexes. The uretero-ileal stenosis rate is estimated to be 11% with the initial CAMEY-LE DUC technique. A new anastomosis technique is presented in order to improve this postoperative complication.
MATERIALS AND METHODS
Two 5 to 10 cm ileal segments are prepared at the two extremities of the W of the neobladder to receive the largely spatulated ureters. The anastomosis is performed directly on the ileal resection margin, in a strictly retroperitoneal position. Between December 1996 and December 1998, the technique was performed in 89 patients including 19 women. One hundred and sixty six renal units (RU) were analysed by preoperative renal ultrasound, repeated after 1, 3 and 6 months and then every 6 months. Urine culture was performed monthly for 6 months.
RESULTS
Thirteen RU were dilated (grade II and III) preoperatively (7.8%). No secondary anastomotic stenosis was observed with a mean follow-up of 5.8 +/- 7.6 months. Of the 166 RU examined, 129 were normal, 13 preoperative dilatations were improved and 24 RU presented minimal postoperative dilatation (grade I). Ileo-ureteric reflux was observed on the postoperative retrograde cystography in two cases. The only complication was acute pyelonephritis (1.1%) at 1 month. 90% of urine cultures were sterile after 6 months.
CONCLUSION
Modification of uretero-ileal anastomosis by the "double chimney" technique is performed without tension by placing the two ureters in an anatomical position without plication or torsion. Preservation of the ureteric blood supply contributes to the low complication rate and a decreased risk of stenosis. However, the technique needs to be validated by analysis of the results with a longer follow-up.