Yang—Monti管与阑尾在膀胱可控性流出道应用中的疗效比较

A comparison of the Yang-Monti and appendix in the practice of the continent urinary diversion

目的 比较Yang－Monti管与阑尾在膀胱可控性尿流改道治疗中的应用疗效。 方法回顾性分析我院2009年7月至2015年12月收治的27例神经源性膀胱患儿的临床资料。男8例，女19例。年龄1.5～16.0岁，平均7.6岁。膀胱容量（203.8±126.0）ml，其中膀胱顺应性〈20 ml/ cmH2O（1 cmH2O＝0.098 kPa）者24例，术前发热性尿路感染17例，压力性尿失禁6例，排尿困难17例。27例中7例行Yang－Monti管代膀胱流出道手术（YM组），男2例，女5例；年龄4.0～16.0岁，平均6.7岁。20例行阑尾代膀胱流出道手术（AP组），男6例，女14例；年龄1.5～14.0岁，平均8.0岁。通过记录两组的3 d导尿日记及导尿情况，比较两组在平均导尿间隔、平均单次导尿量、流出道狭窄、流出道漏尿方面的差异。 结果 YM组7例中，2例行开放手术，5例行腹腔镜手术（其中2例中转开放手术）；AP组20例中，3例行开放手术，17例行腹腔镜手术（其中1例中转开放手术），两组的手术时间、术中输血例数和住院时间差异均无统计学意义（均P〉0.05）。YM组7例术后随访1～7年，平均2.4年，平均单次导尿量（239.3±76.2）ml，平均导尿间隔时间（2.8±0.9）h；其中术后随访1～3年者6例，平均导尿间隔时间（2.6±0.8）h。术后1例出现流出道狭窄，1例漏尿。AP组20例术后随访时间1～7年，平均3.0年，平均单次导尿量（257.0±67.4）ml，平均导尿间隔时间（3.9±0.9）h；其中术后随访1～3年者6例，平均导尿间隔时间（3.5±1.0）h。术后1例出现流出道狭窄，2例漏尿。两组患儿在平均单次导尿量、流出道狭窄、流出道漏尿这几项指标间的差异均无统计学意义（均P〉0.05）；两组患儿平均导尿间隔时间差异有统计学意义（P〈0.05），但术后随访1～3年的患儿平均导尿间隔时间的差异无统计学意义（P〉0.05）。结论 Yang－Monti管代流出道手术与阑尾代流出道手术术后并发症发生率相似，疗效接近，对无法用阑尾做流出道的患者，可考虑采用Yang－Monti管制作可控性膀胱流出道。

To compare the outcomes of Yang-Monti channels and appendix in the practice of catheterizable continent urinary conduits.Methods Retrospective analyses were conducted in 27 cases with neurogenic bladder from July 2009 to December 2015, including 8 male and 19 female patients whose average age at surgery was 7.6 years old （range： 1.5-16 years）. The average bladder volume is （203.8±126.0） ml. The bladder compliance values of 24 cases are lower than 20 ml/cm H2O. Seventeen cases had urinary infection combined with fever before surgery, while 6 cases had stress urinary incontinence and 17 cases had dysuria. Seven cases including 2 male patients underwent urinary diversion with Yang-Monti channels （YM group） and the average age at surgery for patients was 6.7 years old（range： 4-16 years）. Twenty cases including 6 male patients underwent urinary diversion with appendix （AP group） and the average age at surgery for patients was 8.0 years old（range： 1.5-14 years）. The 3-day urinary diaries were collected in all cases including their records of average catheterization interval, average catheterization volume, stoma stenosis and stoma leakage.The data between the two groups was compared and the statistical analysis was performed. Results Of the 7 patients undergoing Yang-Monti channels, 2 cases underwent open surgery and 5 cases underwent laparoscopic surgery in which 2 cases transferred to open surgery. The stoma stenosis occurred in 1 case and the stoma leakage occurred in 1 case. The average catheterization volume is （239.3±76.2） ml and the average catheterization interval is（2.8±0.9）h. Six patients in the group were followed up less than 3 years, of which the average catheterization interval is （2.6±0.8）h. Of the 20 patients undergoing appendix channels, 3 cases underwent open surgery and 17 cases underwent laparoscopic surgery in which 1 case transferred to open surgery. The stoma stenosis occurred in 1 case and the stoma leakage occurred in 2 cases. The average catheterization volume is （257.0±67.4）ml and the average catheterization interval is（3.9±0.9）h. Six patients in the group were followed up less than 3 years, of which the average catheterization interval is（3.5±1.0） h. There was no difference in stoma stenosis and stoma leakage and average catheterization volume between the two groups（P〉0.05）. There was no difference in average catheterization interval between the patients of two groups who were followed up less than 3 years （P〉0.05）.Conclusions Yang-Monti conduits are durable and reliable, which was similar with appendix conduits.