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

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

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.