目的:我们研究的目的是证明大陆皮肤尿流改道(CCUD)在肿瘤患者中的实际应用,专注于手术的各个方面:手术挑战,功能结果,和生活质量。
方法:我们研究了因与CCUD相关的癌症而接受膀胱切除术的患者的围手术期和随访数据(Mitrofanoff,蒙蒂或卡萨莱)。我们回顾性分析了术后30天内和30天内的并发症。我们评估了肿瘤学结果。使用膀胱癌指数(BCI)问卷评估患者的生活质量。结果是在意向治疗的基础上给出的。
结果:共有24名患者被纳入研究(2001年7月和2022年5月),中位随访时间为62.5个月。我们报告了3例因肿瘤复发而死亡。46%有术后早期并发症,其中两人需要翻修手术。总的来说,中期并发症发生率为83%,再次手术率为62%.造口皮肤狭窄8例(33%)和输尿管回肠狭窄3例(12.5%)。总体满意度平均为9.2/10,62.5%的患者的身体形象未改变或略有改变。在对BCI有反应的患者中,有75%的患者完全失禁。
结论:在神经泌尿学中使用大陆气孔获得的经验允许,在精心挑选的案例中,为患者提供一种替代方案,可以在已经承受癌症阴影的情况下改善他们的生活质量。在尿道侵入或新膀胱尿失禁的高风险情况下,CCUD可以作为Bricker改道的替代方案。在选定的患者中。
OBJECTIVE: The objective of our study is to demonstrate the practical application of continent cutaneous urinary diversion (CCUD) in oncological patients, with a focus on various aspects of the procedure: surgical challenges, functional outcomes, and quality of life.
METHODS: We studied the perioperative and follow-up data of patients who underwent cystectomy for cancer associated with CCUD (Mitrofanoff, Monti or Casale). We retrospectively analyzed complications within 30days and beyond 30days post-surgery. We evaluated oncological outcomes. Patients\' quality of life was assessed using the Bladder Cancer Index (BCI) questionnaire. Results are given on an intention-to-treat basis.
RESULTS: A total of 24 patients were included in the study (July 2001 and May 2022), with a median follow-up of 62.5months. We report three deaths due to neoplasic recurrence. Forty-six percent had an early postoperative complication, two of whom required revision surgery. Overall, the medium-term complication rate was 70% and the reoperation rate was 62%. There were 8 stomal cutaneous stenoses (33%) and 3 uretero-ileal stenoses (12.5%). Overall satisfaction was rated at 9.2/10 on average, and body image was unaltered or slightly altered in 62.5% of patients. Of the patients who responded to the BCI, 75% had complete continence.
CONCLUSIONS: The experience gained with continent stomas in neuro-urology has allowed, in carefully selected cases, to offer patients an alternative that can improve their quality of life in a context already burdened by the shadow of cancer. CCUD can be proposed as an alternative to Bricker diversion in cases of urethral invasion or a high risk of neobladder incontinence, in selected patients.
METHODS: