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

doi:10.3877/cma.j.issn.1674-3253.2022.03.002

Abstract

Abstract:

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.

Key words: Bladder cancer, Cystectomy, Urinary diversion, Tubeless, Stent

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]. Chinese Journal of Endourology(Electronic Edition), 2022, 16(03): 198-203.

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References 27

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组别	例数	性别（例）		年龄[岁，(±s)]	BMI[kg/m³，(±s)]	高血压[例(%)]	糖尿病[例(%)]	ASA评分(例)			术前血红蛋白[g/L，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m³，(±s)]	高血压[例(%)]	糖尿病[例(%)]	Ⅰ级	Ⅱ级	Ⅲ级或Ⅳ级	术前血红蛋白[g/L，(±s)]
外支架管组	48	42	06	64±12	22.4±3.7	11（22.9）	8（16.7）	31	12	5	130.17±18.28
内支架管组	09	08	01	63±80	22.4±1.3	02（22.2）	0（0）0.0	05	04	0	125.00±27.99
无管组	43	33	10	63±12	24.2±4.5	06（31.6）	4（9.3）0	27	15	1	127.37±19.42
统计值		χ² =2.103		F=0.294	F=0.542	χ² =1.251	χ² =2.497	χ² =4.458			F=0.382
P值		0.349		0.746	0.587	0.535	0.287	0.348			0.683
组别	术前血肌酐[μmol/l，(±s)]	术前肾积水[例(%)]	临床T分期(例)		N分期(例)）		病理分型(例)				术后随访时间[月，(±s)]
组别	术前血肌酐[μmol/l，(±s)]	术前肾积水[例(%)]	T₁或T₂	T₃或T₄	阳性	阴性	移行上皮癌	鳞癌	腺癌	其他	术后随访时间[月，(±s)]
外支架管组	92±31	6（12.5）	43	5	4	44	45	1	1	1	14±16
内支架管组	85±26	1（11.1）	08	1	1	8	9	0	0	0	6±4
无管组	89±29	1（2.3）0	34	9	2	41	40	1	1	1	16±13
统计值	F=0.255	χ² =3.320	χ² =2.084		χ² =0.729		χ² =0.635				F=1.705
P值	0.775	0.190	0.353		0.694		0.995				0.188

组别	例数	性别（例）		年龄[岁，(±s)]	BMI[kg/m³，(±s)]	高血压[例(%)]	糖尿病[例(%)]	ASA评分(例)			术前血红蛋白[g/L，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m³，(±s)]	高血压[例(%)]	糖尿病[例(%)]	Ⅰ级	Ⅱ级	Ⅲ级或Ⅳ级	术前血红蛋白[g/L，(±s)]
外支架管组	48	42	06	64±12	22.4±3.7	11（22.9）	8（16.7）	31	12	5	130.17±18.28
内支架管组	09	08	01	63±80	22.4±1.3	02（22.2）	0（0）0.0	05	04	0	125.00±27.99
无管组	43	33	10	63±12	24.2±4.5	06（31.6）	4（9.3）0	27	15	1	127.37±19.42
统计值		χ² =2.103		F=0.294	F=0.542	χ² =1.251	χ² =2.497	χ² =4.458			F=0.382
P值		0.349		0.746	0.587	0.535	0.287	0.348			0.683
组别	术前血肌酐[μmol/l，(±s)]	术前肾积水[例(%)]	临床T分期(例)		N分期(例)）		病理分型(例)				术后随访时间[月，(±s)]
组别	术前血肌酐[μmol/l，(±s)]	术前肾积水[例(%)]	T₁或T₂	T₃或T₄	阳性	阴性	移行上皮癌	鳞癌	腺癌	其他	术后随访时间[月，(±s)]
外支架管组	92±31	6（12.5）	43	5	4	44	45	1	1	1	14±16
内支架管组	85±26	1（11.1）	08	1	1	8	9	0	0	0	6±4
无管组	89±29	1（2.3）0	34	9	2	41	40	1	1	1	16±13
统计值	F=0.255	χ² =3.320	χ² =2.084		χ² =0.729		χ² =0.635				F=1.705
P值	0.775	0.190	0.353		0.694		0.995				0.188

组别	手术时间[min，(±s)]	术中输血[例(%)]	血红蛋白丢失量[g/L，M(Q)]	血量丢失估算[ml，M(Q)]	术前术后血清肌酐差值[μmol/L，M(Q)]]	术后住院时间[d，(±s)]
外支架管组	469±120	8（16.7）	14（23）	200（200）	23（37）	20.6±12.6
内支架管组	365±880	2（22.2）	09（37）	150（175）	03（46）	9.0±2.3
无管组	457±980	4（9.3）0	10（25）	200（150）	25（41）	21.3±11.1
统计值	F=3.488	χ² =1.557	H=1.554	H=1.209	H=3.660	F=4.572
P值	0.034	0.455	0.460	0.546	0.160	0.013
组别	术后并发症[例(%)]						术后30 d再入院[例(%)]	并发症评分（The Clavien.）[例(%)]				近期并发症[例(%)]	死亡病例[例(%)]
组别	尿漏	肠梗阻	尿培养阳性	症状性尿路感染	伤口愈合不良	吻合口狭窄	术后30 d再入院[例(%)]	Ⅰ或Ⅱ级	Ⅲ级	Ⅳ级	Ⅴ级	近期并发症[例(%)]	死亡病例[例(%)]
外支架管组	3(6.3)	4(8.3)0	09(18.8)	4(8.3)0	3(6.3)0	5(10.4)	7(14.6)	8(16.7)	6(12.5)	2(4.2)	2(4.2)	14(29.2)	3(6.3)
内支架管组	01(11.1)	0(0)00.	02(22.2)	3(33.3)	1(11.1)	1(11.1)	1(11.1)	1(11.1)	2(22.2)	0(0)0.	0(0)0.	3(33.3)	0(0)0.
无管组	11(25.6)	9(20.9)	18(41.9)	9(20.9)	9(20.9)	4(9.3)0	7(16.3)	9(20.9)	9(20.9)	2(4.7)	0(0)0.	25(59.5)	0(0)0.
χ²值	6.698	4.660	6.043	4.889	4.353	0.045	0.168	4.583				11.70	3.351
P值	0.035	0.097	0.049	0.087	0.113	0.978	0.919	0.801				0.165	0.187

组别	手术时间[min，(±s)]	术中输血[例(%)]	血红蛋白丢失量[g/L，M(Q)]	血量丢失估算[ml，M(Q)]	术前术后血清肌酐差值[μmol/L，M(Q)]]	术后住院时间[d，(±s)]
外支架管组	469±120	8（16.7）	14（23）	200（200）	23（37）	20.6±12.6
内支架管组	365±880	2（22.2）	09（37）	150（175）	03（46）	9.0±2.3
无管组	457±980	4（9.3）0	10（25）	200（150）	25（41）	21.3±11.1
统计值	F=3.488	χ² =1.557	H=1.554	H=1.209	H=3.660	F=4.572
P值	0.034	0.455	0.460	0.546	0.160	0.013
组别	术后并发症[例(%)]						术后30 d再入院[例(%)]	并发症评分（The Clavien.）[例(%)]				近期并发症[例(%)]	死亡病例[例(%)]
组别	尿漏	肠梗阻	尿培养阳性	症状性尿路感染	伤口愈合不良	吻合口狭窄	术后30 d再入院[例(%)]	Ⅰ或Ⅱ级	Ⅲ级	Ⅳ级	Ⅴ级	近期并发症[例(%)]	死亡病例[例(%)]
外支架管组	3(6.3)	4(8.3)0	09(18.8)	4(8.3)0	3(6.3)0	5(10.4)	7(14.6)	8(16.7)	6(12.5)	2(4.2)	2(4.2)	14(29.2)	3(6.3)
内支架管组	01(11.1)	0(0)00.	02(22.2)	3(33.3)	1(11.1)	1(11.1)	1(11.1)	1(11.1)	2(22.2)	0(0)0.	0(0)0.	3(33.3)	0(0)0.
无管组	11(25.6)	9(20.9)	18(41.9)	9(20.9)	9(20.9)	4(9.3)0	7(16.3)	9(20.9)	9(20.9)	2(4.7)	0(0)0.	25(59.5)	0(0)0.
χ²值	6.698	4.660	6.043	4.889	4.353	0.045	0.168	4.583				11.70	3.351
P值	0.035	0.097	0.049	0.087	0.113	0.978	0.919	0.801				0.165	0.187

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