Mainz Ⅱpouch在小儿膀胱外翻治疗中的应用

Application of MainzⅡPouch for children with complete bladder exstrophy

目的探讨改良Mainz II pouch尿流改道手术在小儿膀胱外翻治疗中的应用经验及临床疗效。方法回顾性分析新疆医科大学第一附属医院小儿泌尿外科2009年7月至2019年9月收治的20例行MainzⅡpouch尿流改道手术的膀胱外翻患儿的临床资料,其中男13例,女7例,就诊年龄1~14岁,平均年龄5.2岁;首选MainzⅡpouch治疗18例;一期原位修复手术失败1例,原位修复术后5年持续尿失禁1例,后期分别接受了改道手术。术后对患儿尿控、上尿路功能等情况进行了随访。结果全部患儿创面愈合良好,腹壁、阴茎/外阴外观理想。患儿术后随访6~122个月,平均48个月,均未出现严重并发症,20例患儿中16例可完全控制排尿,3例日间可控制排尿,夜间仍需带尿片。1例仍完全失禁等待进一步治疗。2例出现上尿路轻中度扩张积水。未出现肾功能受损,严重代谢紊乱及酸碱失衡。结论用MainzⅡpouch手术治疗延期就诊,膀胱体积较小且黏膜水肿、角化严重,原位修复失败的膀胱外翻尿控效果理想,无需多次手术,腹壁无造口,术后无需带集尿袋,可有效地保护上尿路功能等特点,尤其适用于小儿膀胱外翻的治疗。

Objective Continent anal urinary diversion is ideal for bladder exstrophy.We reported our long-term results with rectosigmoid pouch(MainzⅡpouch),a modification of classic ureterosigmoidostomy.Methods A total of 20 children with a mean age of 5.2(1-14)years underwent Mainz pouchⅡprocedure between 2009 and 2019.And 18 cases received the treatment as the first option.Primary closure failed in one child and another developed severe incontinence after 5 years of primary closure.Renal function,continence and metabolic changes were analyzed.Results During a mean follow-up period of 48(6-122)months,16 children stayed continent during daytime while 3 cases of nighttime incontinence required padding.One child of total incontinence awaited further interventions.With respect to upper urinary tract,2 children had mild-moderate pyelonephritis,Serum creatinine remained within normal limits.During follow-ups,acid-base balance was monitored and there was no onset of metabolic acidosis or renal dysfunction.Conclusion Mainz II pouch procedure is efficacious for delayed complete bladder exstrophy with failed primary closure and small bladder capacity.Without stoma,appliance or catheterization,this type of continent urinary diversion is preferred for children.