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中华腔镜泌尿外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 198 -203. doi: 10.3877/cma.j.issn.1674-3253.2022.03.002

临床研究

腹腔镜膀胱癌根治术尿道改流留置外、内支架管与无管化的对比研究
肖东明1, 刘硕儒1, 张斌1, 李茂胤1, 黄文涛1, 张浩1, 胡成1,()   
  1. 1. 510630 广州,中山大学附属第三医院泌尿外科
  • 收稿日期:2021-12-09 出版日期:2022-06-01
  • 通信作者: 胡成

A comparative study of indwelling external, internal stents and tubeless for ureteroenteric anastomosis of laparoscopic radical cystectomy with urinary diversion

Dongming Xiao1, Shuoru Liu1, Bin Zhang1, Maoyin Li1, Wentao Huang1, Hao Zhang1, Cheng Hu1,()   

  1. 1. Department of Urology, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
  • Received:2021-12-09 Published:2022-06-01
  • Corresponding author: Cheng Hu
引用本文:

肖东明, 刘硕儒, 张斌, 李茂胤, 黄文涛, 张浩, 胡成. 腹腔镜膀胱癌根治术尿道改流留置外、内支架管与无管化的对比研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2022, 16(03): 198-203.

Dongming Xiao, Shuoru Liu, Bin Zhang, Maoyin Li, Wentao Huang, Hao Zhang, Cheng Hu. A comparative study of indwelling external, internal stents and tubeless for ureteroenteric anastomosis of laparoscopic radical cystectomy with urinary diversion[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(03): 198-203.

目的

比较腹腔镜膀胱癌根治术尿道改流(RCUD)中留置外、内支架管与无管化术后的效果。

方法

回顾性分析100例于2015年1月至2021年1月在中山大学附属第三医院泌尿外科行RCUD膀胱癌患者的资料。根据术中的处理方法不同分为外支架管组(48例)、内支架管组(9例)和无管组(43例)。统计学分析三组患者的基本资料、围手术期指标以及术后并发症等情况。

结果

RCUD术后尿漏总发生率为15%,外支架组明显低于无管组(6.3% vs 25.6%,P=0.031),内支架管组的发生率为11.1%;尿培养阳性率为29%,外支架管组明显低于无管组(18.8% vs 41.9%,P=0.047),内支架管组的发生率为22.2%;三组患者间内支架管组手术时间更短[(365±88)min vs (469± 120)min vs (457±98)min,P=0.034];内支架管组术后住院时间更短[(9.0±2.3)d vs (20.6±12.6)d vs(21.3±11.1)d,P=0.013]。患者RCUD术后肠梗阻发生率(P=0.097)、伤口愈合不良发生率(P= 0.113)、输尿管肠吻合口狭窄(UEAS) (P=0.978)、术后30 d再入院率(P=0.919)和总并发症评分(P=0.801)组间差异无统计学意义。

结论

膀胱癌根治术中使用内支架管安全可靠,可明显缩短手术时间和术后住院时间。与无管化相比,放置外支架管可明显降低术后尿漏的发生率和术后尿路感染风险。

Objective

To compare the postoperative effects of indwelling external, internal stents and tubeless for uretero-enteric anastomosis of laparoscopic radical cystectomy with urinary diversion (RCUD).

Methods

The data of 100 patients with bladder cancer underwent laparoscopic radical cystectomy with urinary diversion in the Department of Urology, the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to January 2021 were retrospectively analyzed. According to different intraoperative treatment methods, they were divided into external stent group (48 cases), internal stent group (9 cases) and tubeless group (43 cases), of which the basic data, perioperative indicators and postoperative complications were compared and analyzed.

Results

The total incidence of urine leakage after RCUD was 15%, which was significantly lower in the external stent group than in the tubeless group (6.3% vs 25.6%, P=0.031), while the internal stent group was 11.1%. The positive rate of urine culture was 29 %, only was the external stent group significantly lower than the tubeless group (18.8% vs 41.9%, P=0.047), while the internal stent group was 22.2%. The operation time and the postoperative hospital stay of the internal stent group was shorter than other two groups [(365±88) min vs (469±120) min vs (457±98) min, P=0.034; (9.0±2.3) d vs (20.6±12.6) d vs (21.3±11.1) d, P=0.013]. There were no significant differences in the incidence of postoperative intestinal obstruction (P=0.097), poor wound healing (P=0.113), ureteroenteric anastomosis stricture (UEAS) (P=0.978), and the rate of readmission 30 days after surgery (P=0.919) and total complication score (P=0.801) among the three groups.

Conclusion

Indwelling the internal stent in RCUD is safe and reliable, and it can significantly shorten the operation time and postoperative hospital stay. For tubeless, indwelling the external stent can significantly reduce the incidence of postoperative urine leakage and the risk of postoperative urinary tract infection.

表1 三组腹腔镜膀胱癌尿流改道患者基本资料的比较
表2 三组腹腔镜膀胱癌尿流改道患者围手术期指标和术后并发症情况比较
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