Demucosalized augmentation gastrocystoplasty with bladder autoaugmentation in pediatric patients
Demucosalized augmentation gastrocystoplasty with bladder autoaugmentation in pediatric patients
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DOI：
10.1016/s0022-5347(01)66001-4
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发表时间：
1996-07-01
影响因子：
6.6
通讯作者：
Carr, MC
中科院分区：
文献类型：
--
作者：
Nguyen, DH;Mitchell, ME;Carr, MC
目的：胃肠道粘膜层的存在是肠或胃尿重建中潜在的代谢并发症。每种组织的优点或缺点一直存在争议。我们报告了一种手术，其中胃蒂皮瓣的粘膜被移除，剩余的肌层皮瓣转移到自体增强膀胱。材料与方法：1992年10月至1994年11月在我院行该手术的患者为7名女性和4名男性。回顾性回顾图表，比较术前和术后尿动力学结果、尿失禁状况和并发症。结果：平均随访23个月（8 ~ 33个月）。术前尿动力学显示平均膀胱容量为109毫升（范围45至200），顺应性为3毫升/厘米。水（范围1至6）。每3 ~ 4小时清洁间歇导尿10例尿失禁，1例尿湿，尿道阻力低。所有患者术后均行尿动力学检查。膀胱容量增加到236毫升（150至300），平均顺应性为9毫升/厘米。水（范围5至14）。无代谢并发症。结论：胃肌层似乎与天然尿路上皮一起保存，提供了一种柔顺的组织，可以替代肠和胃进行膀胱增强。由于该手术涉及胃补片的脱粘膜以及膀胱的自体增大，与正常的胃囊成形术或肠囊成形术相比，手术时间增加。然而;缺乏代谢并发症和无黏液尿是重要的考虑因素和实质性的优势。
Purpose: Potential metabolic complications in urinary reconstruction with bowel or stomach are due to the presence of the gastrointestinal mucosal layer. The advantage or disadvantage of each tissue has been debated. We report a procedure in which the mucosa of a gastric pedicle flap is removed and the remaining muscularis flap is transferred to an autoaugmented bladder.Materials and Methods: Seven female and 4 male patients underwent the procedure at our institutions from October 1992 to November 1994. A retrospective chart review was performed to compare preoperative to postoperative urodynamic findings, continence status and complications.Results: Mean followup was 23 months (range 8 to 33). Preoperative urodynamics showed an average bladder capacity of 109 cc (range 45 to 200) and compliance of 3 ml./cm. water (range 1 to 6). Urinary continence was achieved in 10 patients on clean intermittent catheterization every 3 to 4 hours and 1 was wet due to low urethral resistance. All patients underwent postoperative urodynamics. Bladder capacity increased to 236 cc (range 150 to 300) with an average compliance of 9 ml./cm. water (range 5 to 14). No metabolic complications were noted.Conclusions, The gastric muscularis appears to be preserved along with the native urothelium to provide a compliant tissue that can be an alternative to bowel and stomach for bladder augmentation. Because the procedure involves demucosalizing the gastric patch as well as performing bladder autoaugmentation, operative time is increased compared to normal gastrocystoplasty or enterocystoplasty. However; the lack of metabolic complications and mucus-free urine are important considerations and substantial advantages.