腹腔镜根治性膀胱切除及尿流改道术后输尿管肠吻合口狭窄的影响因素分析

Analysis of influencing factors of ureteral anastomotic stenosis following urinary diversion afterlaparoscopic radical cystectomy

目的探讨腹腔镜根治性膀胱切除+尿流改道术后患者出现输尿管肠吻合口狭窄(UES)的影响因素。方法回顾性分析2008年1月至2016年12月在福建医科大学附属第一医院泌尿外科行腹腔镜根治性膀胱切除+尿流改道术(U D)的412例患者的临床病理资料。收集患者的年龄、性别、体质指数(B M I)、UD术式、UD术后出现UES时间、留置支架管时间、术后并发症(包括泌尿道感染、输尿管肠吻合口漏、UES)等资料。采用Kaplan-Meier曲线分析UD术后出现U ES的时间。C 0 X比例风险回归模型分析UES的影响因素。结果经过中位37个月(17~120个月)随访,412例患者中共有59例70侧出现U ES,其中左侧34例,右侧14例,双侧11例。UD术后出现UES的中位时间为7个月(4~11个月)。全组患者UES总发生率为14.3%,1年、3年、5年内累计发生率分别为10.9%、13.3%、14.1%。C 0 X比例风险回归模型分析显示BMI>25kg/m2(P=0.008)、术后输尿管肠吻合口漏(P=0.001)、术后泌尿道感染(P=0.037)是UD术后出现UES的独立危险因素。结论根治性膀胱切除+UD术后UES的发牛率较高,并且左侧较右侧常见。肥胖患者UD术后并发输尿管肠吻合口漏、泌尿道感染更容易发展为UES。

Objective To investigate the influencing factors of ureteroenteric strictures (UES) inpatients undergoing laparoscopic radical cystectomy plus urinary diversion (UD). Method A total of 412patients who underwent UD after radical prostatectomy from January 2008 to December 2016 wereretrospectively included in this study. Age, gender, body mass index (BMI), diversion type, time to diagnosisof UES, duration of ureteral stent, postoperative complications, including urinary tract infections,ureteroenteric leakage and UES were collected. Kaplan-Meier curves were used to describe time todeveloping UES. Prognostic factors of UES were analyzed using COX proportional hazard regression model.Result Median follow-up time was 37 (IQR 17-120) months. A total of 59 patients (70 sides) developedUES, including 34 cases on the left side, 14 cases on the right side and 11 cases on both sides, following UDafter radical cystectomy. The median time to diagnosis of UES was 7 (IQR 4-11) months. The total incidenceof UES was 14.3%. The incidence of UES was 10.9%, 13.3% and 14.1% at 1, 3 and 5 years after UD,respectively. Cox proportional hazard regression model analysis demonstrated that BMI^25kg*m2(P=0.008),ureteroenteric leakage (P=0.001) and urinary tract infections (P=0.037) were the independent risk factorsassociated with UES following UD after radical cystectomy. Conclusion The incidence rate of UESfollowing UD after radical cystectomy was relatively high, which occurs more common on the left side. Obesepatients, combined with ureteroenteric leakage, urinary tract infection after UD, are more likely to developinto UES.