对浸润性膀胱癌膀胱全切双侧输尿管腹壁移植造口术的评价

Evaluation of the cutaneous ureterostomy technique for radical cystectomy in cases of invasive bladder cancer

目的比较浸润性膀胱癌膀胱全切双侧输尿管腹壁造口术和回肠代膀胱术两种术式的临床效果。方法回顾性分析了2012年4月-2015年4月期间57例患者的临床资料，其中30例患者接受了膀胱全切双侧输尿管腹壁造口术和27例回肠代膀胱术。从以下方面：吻合口感染，输尿管乳头萎缩、末端坏死，尿漏，输尿管外口狭窄，手术时间，术中出血，住院时间和造口组拔管时间及健康相关的生活质量（HRQOL）评价两种术式临床效果。结果采用双侧输尿管腹壁造口术治疗方法的并发症明显低于回肠代膀胱组并发症的发生率，且差异有统计学意义（P〈0．05）。手术时间，术中出血，住院时间和造口组拔管时间同样低于回肠代膀胱组（P〈0．05）。健康相关的生活质量（HRQOL）双侧输尿管腹壁造口术明显高于回肠代膀胱组（P〈0．05）。结论双侧输尿管腹壁造口术是一种临床效果较好的尿流改道手术方式。

Objective To compare clinical effects of cutaneous ureterostomy technique in radical cystectorny with an ileal conduit urinary diversion. Methods Clinical data from 57 patients who underwent one of the two procedures between April 2012 and April 2015 were analyzed retrospectively. In total, 30 patients underwent a cutaneous ureterostomy and 27 underwent an ileal conduit urinary diversion following radical cystectomy. The incidence of complications, including stoma infection, nipple atrophy, terminal necrosis, urine leakage, external orifice ste- nosis, uronephrosis and ureterectasia were compared. Results The incidence of complications in the group of patients treated with a cutaneous ureterostomy technique was significantly lower than that of the patients in an ileal conduit urinary diversion. In addition, the duration of the surgery, intra-operative bleeding, the duration of the hospitalization period and the time to extubation in the patients treated with the cutaneous ureterostomy technique were significantly decreased （P 〈 0. 05 ） compared with the patients in the group of the ileal conduit urinary diversion. Finally, the health-related quality of life of the patients treated with the cutaneous ureterostomy technique was significantly higher （P 〈 0. 05） than the other group. Conclusion The cutaneous ureterostomy technique is a good operation method of urinary diversion.