回肠膀胱腹壁造瘘术与Bricker术的疗效对比

目的分别对全膀胱切除术后行回肠膀胱腹壁造瘘术、Bricker术的膀胱尿路上皮癌患者进行长期随访,评价两种尿流改道术式的临床疗效。方法 2010年1月至2019年4月,我科共行98例全膀胱切除术,其中57例行回肠膀胱腹壁造瘘术(造瘘术组),41例行Bricker术(Bricker术组),比较两种不同术式患者的一般资料、围手术期情况、术后并发症等。结果两组一般临床资料比较,差异无显著统计学意义(P>0.05);造瘘术组平均手术时间(4.4±0.3)h,显著低于Bricker术组(5.8±0.3)h(P<0.05),但两组在术中出血、术后住院时间、术后拔除盆腔引流管时间、术后拔除输尿管支架时间等方面无统计学差异(P>0.05);造瘘术组术后总肾功异常发生率(2.0%vs.11.2%)、造瘘口周围皮炎及疤痕发生率(0.0%vs.10.2%)均显著低于Bricker术组(P<0.05)。此外,两组患者在随访时间、术后TNM分期、漏尿、肠梗阻、肾积水、膀胱结石、回肠造瘘口坏死或狭窄等方面均无统计学差异(P>0.05)。结论与Bricker术相比,回肠膀胱腹壁造瘘术临床疗效可靠,手术疗效无明显差别,但手术时间更短,术后总肾功异常发生率更低、造瘘口并发症更少,可弥补Bricker术的不足,有望成为更加理想的尿流改道术式。

A comparative analysis of efficacy of ileum bladder abdominal wall fistula and Bricker

Objective To compare the clinical efficacy of ileum bladder abdominal wall fistula and Bricker in the treatment of bladder urothelial carcinoma.Methods The clinical data of 98 patients with bladder urothelial carcinoma who underwent total cystectomy during Jan.2010 and Apr.2019 in our department were reviewed.Ileum bladder abdominal wall fistula was performed in 57 cases(study group),and Bricker in 41 cases(control group).General information,perioperative data and postoperative complications were compared between the two groups.Results There were no significant differences in baseline data between the two groups(P>0.05).The average operation time was(4.4±0.3)h in the study group,which was significantly lower than that in the control group(5.8±0.3) h,(P<0.05).There were no statistical differences between the two groups in terms of intraoperative hemorrhage,postoperative hospitalization time,time to remove pelvic drainage,and time to remove ureteral stent(P> 0.05).The study group had significantly lower incidences of total renal dysfunction(2.0% vs.11.2%) and peristomal dermatitis and scarring(0.0% vs.10.2%) than the control group(P<0.05).There were no statistical differences between the two groups in terms of follow-up time,postoperative TNM stage,urinary leakage,intestinal obstruction,hydronephrosis,bladder stones,ileostomy necrosis or stenosis(P>0.05).Conclusion Ileum bladder abdominal wall fistula has a comparable efficacy as Bricker.It has shorter operation time,lower incidence of total renal dysfunction and fewer complications of fistula.It can be an alternative of Bricker as a better way of urinary diversion.