背景:回肠袋是一种要求苛刻的手术,具有许多潜在的技术并发症,包括膀胱或输尿管损伤,而吻合口或肛门过渡区的炎症或狭窄可能导致狭窄和瘘的形成,包括邻近的尿道。小袋尿路瘘很少见。我们的目的是描述演示文稿,诊断检查,以及我们中心对尿袋患者的管理。
方法:我们使用诊断代码和自然语言处理自由文本搜索来查询我们前瞻性维护的囊袋注册表,以识别1997年至2022年被诊断为任何囊袋尿路瘘的回肠囊袋患者。给出了使用Kaplan-Meier曲线的描述性统计和囊存活率。数字代表频率(比例)或中位数(范围)。
结果:超过25年,观察到尿瘘27例患者;其中,16个索引袋在我们的机构进行[比率0.3%(16/5236)]。总体中位年龄为42(27-62)岁,92.3%的患者为男性。瘘部位包括13例患者的囊袋尿道(48.1%),12例患者(44.4%)的囊袋膀胱,和肛门尿道2(7.4%)。从囊袋到瘘的中位时间为7.0(0.3-38)年。12例患者进行了囊袋切除和末端回肠造口术(膀胱瘘,n=3;尿道瘘,n=9),5例患者进行了回肠袋-肛门吻合术(IPAA)(膀胱瘘,n=3;尿道瘘,n=2)。膀胱瘘后5年总储袋生存率为58.3%。33.3%伴尿道瘘(p=0.25)。
结论:袋尿路瘘是一种罕见的,病态,并且难以治疗需要多学科的回肠袋并发症,经常上演,手术方法。从长远来看,膀胱瘘的小袋比尿道瘘的小袋更容易被挽救。
BACKGROUND: Ileoanal pouch is a demanding procedure with many potential technical complications including bladder or ureteral injury, while inflammation or stricture of the anastomosis or anal transition zone may lead to the formation of strictures and fistulae, including to the adjacent urethra. Pouch urinary tract fistulae are rare. We aimed to describe the presentation, diagnostic workup, and management of patients with pouch urinary at our center.
METHODS: Our prospectively maintained pouch registry was queried using diagnostic codes and natural language processing free-text searches to identify ileoanal pouch patients diagnosed with any pouch-urinary tract fistula from 1997 to 2022. Descriptive statistics and pouch survival using Kaplan-Meier curves are presented. Numbers represent frequency (proportion) or median (range).
RESULTS: Over 25 years, urinary fistulae were observed 27 pouch patients; of these, 16 of the index pouches were performed at our institution [rate 0.3% (16/5236)]. Overall median age was 42 (27-62) years, and 92.3% of the patients were male. Fistula locations included pouch-urethra in 13 patients (48.1%), pouch-bladder in 12 patients (44.4%), and anal-urethra in 2 (7.4%). The median time from pouch to fistula was 7.0 (0.3-38) years. Pouch excision and end ileostomy were performed in 12 patients (bladder fistula, n = 3; urethral fistula, n = 9), while redo ileal pouch-anal anastomosis (IPAA) was performed in 5 patients (bladder fistula, n = 3; urethral fistula, n = 2). The 5-year overall pouch survival after fistula to the bladder was 58.3% vs. 33.3% with urethral fistulae (p = 0.25).
CONCLUSIONS: Pouch-urinary tract fistulae are a rare, morbid, and difficult to treat complication of ileoanal pouch that requires a multidisciplinary, often staged, surgical approach. In the long term, pouches with bladder fistulae were more likely to be salvaged than pouches with urethral fistulae.