背景:关于尿流改道+膀胱切除术后作为良性膀胱适应症治疗的发病率的证据很少。
目的:进行发病率评估,并评估伴随三角下膀胱切除术(SC)与单独尿流改道(UD)的影响。
方法:这是2009年至2017年间97例良性膀胱疾病患者的回顾性研究。
方法:打开UD和/或伴随SC。
方法:使用特定程序目录提取30天并发症的数据,并根据Clavien-Dindo分类(CDC)进行分级,并计算综合并发症指数(CCI)值。传统的发病终点集中于UD+SC与单独UD的比较发病率。计算多变量回归以评估SC与UD单独对累积发病率的影响。对先前接受过照射的患者重复进行亚组分析。
结论:在97例患者中,46例(47%)接受UD+SC,51例(53%)单独接受UD。49例患者(51%)有腹骨盆放疗史。总的来说,69例(71%)患者接受了大陆UD,26例(27%)接受了Mitrofanoff手术。我们记录了97例(100%)患者的390例并发症,其中大多数被归类为次要(CDC等级≤IIIa;93%).总的来说,3例患者(3.1%)再次入院,30d内无患者死亡。在多变量分析中,同时进行SC和既往放疗均未与较高的累积发病率相关(均p=0.2).同样,在照射亚组中,伴随SC不能预测更高的并发症负担(均p≥0.05).局限性包括适应症的异质性以及缺乏有关辐射剂量和场的信息。
结论:在高容量的转诊中心,对于接受UD的良性膀胱疾病患者,SC和腹骨盆放射疗法均未增加围手术期累积发病率。这对于将受益于伴随SC以避免与保留的膀胱相关的不良后遗症的患者尤其相关。
结果:尿流(UD)是一种外科手术,旨在为尿液排出体内创造一种新的途径。我们发现,在因良性膀胱疾病而接受UD的患者中,那些也切除了膀胱的患者和以前接受过放射治疗的患者不会出现更多的并发症。
Evidence is scarce on morbidity after urinary diversion ± cystectomy as treatment for benign bladder indications.
To conduct a morbidity assessment and to evaluate the impact of concomitant subtrigonal cystectomy (SC) versus urinary diversion (UD) alone.
This was a retrospective study of 97 patients with benign bladder conditions between 2009 and 2017.
Open UD and/or concomitant SC.
Data for 30-d complications were extracted using a procedure-specific catalog and were graded according to the Clavien-Dindo classification (CDC), and Comprehensive Complication Index (CCI) values were calculated. Traditional morbidity endpoints focused on the comparative morbidity of UD + SC versus UD alone. Multivariable regressions were computed to evaluate the impact of SC versus UD alone on cumulative morbidity. Subgroup analyses were repeated for patients with previous irradiation.
Of 97 patients, 46 (47%) underwent UD + SC and 51 (53%) underwent UD alone. Forty-nine patients (51%) had a history of abdominopelvic radiotherapy. Overall, 69 (71%) patients underwent continent UD and 26 (27%) underwent a Mitrofanoff procedure. We registered 390 complications in 97 (100%) patients, the majority of which were classified as minor (CDC grade ≤IIIa; 93%). Overall, three patients (3.1%) were readmitted and no patient died within 30 d. On multivariable analyses, neither concomitant SC nor previous radiotherapy was associated with higher cumulative morbidity (all p = 0.2). Similarly, concomitant SC was not predictive of a higher complication burden in the irradiation subgroup (all p ≥ 0.05). Limitations include heterogeneity for indications and a lack of information on the radiation dose and field.
In a high-volume referral center, neither SC nor abdominopelvic radiotherapy increased perioperative cumulative morbidity for patients with benign bladder conditions undergoing UD. This is particularly relevant for patients who would benefit from concomitant SC to avert adverse sequelae related to the retained bladder.
Urinary diversion (UD) is a surgical procedure to create a new way for urine to exit the body. We found that among patients undergoing UD for benign bladder conditions, those who also have their bladder removed and patients who have received previous radiotherapy do not experience more complications.