Abstract：
BACKGROUND: The need for the left ureter to pass through the subsigmoid during ileal conduit diversion surgery has not been investigated in any studies. A modified technique is simply used in the ileal conduit with the left ureter straight over the sigmoid colon due to the possible damage and lack of scientifically validated advantages of this procedure. Our study aimed to investigate the feasibility of the suggested surgical technique, as well as to evaluate perioperative outcomes and postoperative complications with a focus on the prevalence of small bowel obstruction (SBO) and ureteroileal anastomotic stricture (UAS).
METHODS: A prospective single-center cohort of 84 consecutive patients undergoing laparoscopic radical cystectomy (LRC) and ileal conduit urinary diversion was conducted between January 2018 and April 2020. The incidence of SBO and UAS, perioperative outcomes, and postoperative complications were compared between a trial group of 30 patients receiving the modified procedure and a control group of 54 patients receiving the conventional Bricker ileal conduit.
RESULTS: The two groups were comparable concerning patient characteristics and clinicopathologic features. No differences were observed in terms of the operation time, perioperative outcomes, and short-term (< 90 days) postoperative complications between the two groups. There were no occurrences of UAS in the modified group, while there were two cases (3.70%) in the patients who received Bricker\'s ureteroileal anastomosis (p = 0.535).
CONCLUSIONS: In the present study, a simple and feasible modified technique of ileal conduit is proposed. Compared with traditional techniques, our method has several advantages, including the ability to avoid compression of the left ureter from the mesentery without establishing a retrosigmoid tunnel, a low rate of UAS, and the ability to perform a secondary operation at long-term follow-up.
METHODS: A prospective single-center cohort of 84 consecutive patients undergoing laparoscopic radical cystectomy (LRC) and ileal conduit urinary diversion was conducted between January 2018 and April 2020. The incidence of SBO and UAS, perioperative outcomes, and postoperative complications were compared between a trial group of 30 patients receiving the modified procedure and a control group of 54 patients receiving the conventional Bricker ileal conduit.
RESULTS: The two groups were comparable concerning patient characteristics and clinicopathologic features. No differences were observed in terms of the operation time, perioperative outcomes, and short-term (< 90 days) postoperative complications between the two groups. There were no occurrences of UAS in the modified group, while there were two cases (3.70%) in the patients who received Bricker\'s ureteroileal anastomosis (p = 0.535).
CONCLUSIONS: In the present study, a simple and feasible modified technique of ileal conduit is proposed. Compared with traditional techniques, our method has several advantages, including the ability to avoid compression of the left ureter from the mesentery without establishing a retrosigmoid tunnel, a low rate of UAS, and the ability to perform a secondary operation at long-term follow-up.
摘要：
背景：在回肠导管改道手术中左输尿管穿过下陷的需求尚未在任何研究中进行过研究。由于可能造成损害且缺乏科学验证的优势，因此仅在回肠导管中使用改良技术，左输尿管直过乙状结肠。我们的研究旨在探讨建议的手术技术的可行性，以及评估围手术期结局和术后并发症，重点关注小肠梗阻（SBO）和输尿管回肠吻合口狭窄（UAS）的患病率。
方法：在2018年1月至2020年4月期间，对84例接受腹腔镜根治性膀胱切除术（LRC）和回肠导管尿流改道的连续患者进行了前瞻性单中心队列研究。SBO和UAS的发生率，围手术期结局,比较了接受改良手术的试验组30例患者和接受常规Bricker回肠导管的对照组54例患者的术后并发症。
结果：两组患者特征和临床病理特征具有可比性。在手术时间方面没有观察到差异，围手术期结局,两组术后短期(<90天)并发症。TherewerenoaccurcesofUASinthemodifiedgroup,而接受Bricker输尿管回肠吻合术的患者中有2例（3.70％）（p=0.535）。
结论：在本研究中，提出了一种简单可行的回肠导管改良技术。与传统技术相比，我们的方法有几个优点，包括在不建立乙状结肠后隧道的情况下避免肠系膜压迫左输尿管的能力，UAS的低比率，以及在长期随访中进行二次手术的能力。
方法：在2018年1月至2020年4月期间，对84例接受腹腔镜根治性膀胱切除术（LRC）和回肠导管尿流改道的连续患者进行了前瞻性单中心队列研究。SBO和UAS的发生率，围手术期结局,比较了接受改良手术的试验组30例患者和接受常规Bricker回肠导管的对照组54例患者的术后并发症。
结果：两组患者特征和临床病理特征具有可比性。在手术时间方面没有观察到差异，围手术期结局,两组术后短期(<90天)并发症。TherewerenoaccurcesofUASinthemodifiedgroup,而接受Bricker输尿管回肠吻合术的患者中有2例（3.70％）（p=0.535）。
结论：在本研究中，提出了一种简单可行的回肠导管改良技术。与传统技术相比，我们的方法有几个优点，包括在不建立乙状结肠后隧道的情况下避免肠系膜压迫左输尿管的能力，UAS的低比率，以及在长期随访中进行二次手术的能力。
