METHODS: Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student\'s t-test for independent groups or Mann-Whitney test. Statistical significance if P < .05.
RESULTS: The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Uretericre implantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%).
CONCLUSIONS: Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.
方法:对使用回肠(回肠导管或原位新膀胱)进行尿流改道的患者进行了长达6年的描述性回顾性研究。人口统计数据,合并症,手术方法,并发症,并收集结果。至少随访1年。组间比较对二分变量采用卡方检验。使用Studentt检验或Mann-Whitney检验比较独立组的定量变量。如果P<0.05,则具有统计学意义。
结果:该研究包括182名患者(男性84%,女性16%)。平均年龄68岁。膀胱切除术入路:腹腔镜(67/37%),机器人辅助(63/35%),开放(43/24%)。尿改道:回肠导管(138/76%)和原位回肠新膀胱(44/24%)。输尿管植入技术:Bricker(108/59%)和Wallace(47/26%)。输尿管回肠吻合口狭窄(50/27%):双侧(26),左(16)和右(8)。根据膀胱切除术的狭窄:腹腔镜(23/46%),机器人辅助(16/32%),开放(9/18%)。狭窄的治疗(33/18%):输尿管再植(13),留置式肾造瘘术(13),内窥镜扩张术(4),肾输尿管切除术(2),子宫内膜切开术(1)。输尿管回肠再植入路:腹腔镜(5/38%),机器人辅助(6/46%),开放(2/15%)。再植入后的结果:再狭窄(0/0%),再干预(3/23%),对侧输尿管回肠狭窄(1/8%)。
结论:膀胱切除术的手术方式不会影响输尿管回肠狭窄的未来发展。腹腔镜和机器人辅助输尿管回肠再植术成功率高。