腹腔镜根治性全膀胱切除术中改良Wallace吻合法回肠流出道术的技术要点和疗效分析

Laparoscopic radical cystectomy with modified Wallace ureteroileal anastomosis:surgical techniques and clinical efficacy

目的探讨改良Wallace吻合法回肠流出道术在腹腔镜根治性全膀胱切除尿流改道术中的技术要点和临床效果。方法回顾性分析2018年1月至2020年12月64例于江苏省人民医院接受腹腔镜根治性全膀胱切除+改良Wallace吻合法回肠流出道术的患者临床资料,包括手术时间、估计失血量和术后并发症发生情况,术后对患者进行随访,观察并分析患者肾积水和血清肌酐水平。技术改良主要包括腹腔镜下多种技术保留输尿管血供,输尿管和回肠流出道开放吻合技术改良。结果所有患者术中平均双侧输尿管游离时间为(26.0±3.5)min,平均改良Wallace吻合时间为(17.5±2.5)min。中位随访时间为16.2个月,术后3.1%(2/64)的患者出现中度左肾积水:其中1例行经皮肾穿刺造瘘和抗感染治疗后肾积水消失,顺行造影未见输尿管肠吻合狭窄后拔除肾造瘘管;1例经抗感染治疗后肾积水消失,随访未出现肾积水复发。结论腹腔镜下根治性全膀胱切除术中改良Wallace吻合回肠流出道术安全可行,术后输尿管回肠吻合口狭窄率低。

Objective To investigate the surgical techniques and clinical efficacy of a modified Wallace ureteroileal anastomosis in urinary diversion after laparoscopic radical cystectomy.Methods Clinical data of 64 patients who underwent laparoscopic radical cystectomy and ileal conduit using modified Wallace ureteroileal anastomosis during Jan.2018 and Dec.2020 were retrospectively analyzed,including operation time,estimated blood loss,complications,hydronephrosis and serum creatinine.The modified techniques included multiple laparoscopic ureter-blood supply preserving procedures,and open ureteroileal anastomosis modifying techniques.Results The mean duration of bilateral ureter isolation and modified Wallace ureteroileal anastomosis was(26.0±3.5)minutes and(17.5±2.5)minutes,respectively.During the median follow-up of 16.2 months,2 patients(3.1%)developed hydronephrosis,one of whom was treated with percutaneous nephrostomy and antibiotics,and the other was cured with antibiotics.Conclusion Our results showed that the modified Wallace ureteroileal anastomosis techniques are safe and applicable for ileal conduit construction during laparoscopic radical cystectomy,with low incidence of postoperative ureteroileal anastomotic stricture.