阑尾或肠管可控输出道在神经源性膀胱治疗中的应用

目的：评价阑尾或肠管可控输出道在高反射性神经源性膀胱治疗中的应用价值。方法：采用阑尾输出道（Mitrofanoff法）治疗高反射性神经源性膀胱患者4例,采用回肠腹壁造口（Yang-Monti法）治疗2例。3例采用膀胱自扩大,同时行阑尾输出道2例,回肠腹壁造口1例;3例行回肠膀胱扩大,同时采用阑尾腹壁造口2例,回肠腹壁造口1例。结果：术后随访3～39个月（平均20个月）。1例采用回肠扩大阑尾VZQ造口的患者术后2周造口部皮瓣感染坏死,改行阑尾直接造口;1例阑尾输出道出现造口部位漏尿,缩短导尿间隔为2h,漏尿消失;其他患者控尿良好。5例术后肾功能恢复正常,1例保持稳定。结论：阑尾或回肠可控输出道在高反射性神经源性膀胱治疗中是一种安全可靠的方法。

Application of Appendix and Ileum Continent Conduit in the Neurogenic Bladder

Objective：To evaluate the value of appendix and ileum continent conduit in the treatment ol neurogenic bladder. Methods： 6 male patients with hyperreflex neurogenic bladder underwent appendix continent conduit （Mitrofanoff） in 4 cases and conduit ileostomy （Yang-Monti） in 2 cases. 3 case with bladder autoaugermentation underwent appendix continent conduit in 2 cases, and conduit ileostomy in 1 case. 3 case with bladder augmenta- tion ileocystoplasty underwent appendix continent conduit in 2 cases, and conduit ileostomy in 1 case. Results：The follow-up was 3-39 months （mean 20 months）. 1 patient underwent appendix augmentation VZQ ileocystoplasty, who was found VZQ skin necrosis 2 weeks postoperatively, then underwent appendix stoma. 1 stoma leakage was resolved by shorten the catheterization interval to 2 hours. The others got excellent urinary continence. Renal function was improved in 1 and normalized in 5 patients. Conclusions：The Mitrofanoff appendix and Monti ileum tube were valuable in the treatment of neurogenic bladder.