改良输尿管回肠膀胱吻合及其对术后早期并发症的影响  

Modified ureteroileal anastomosis technique and its effect on early postoperative complications

作　　者：石栋[1] 于德新[1] 张涛[1] 

机构地区：[1]安徽医科大学第二附属医院泌尿外科,合肥230601

出　　处：《临床泌尿外科杂志》2015年第8期737-740,共4页Journal of Clinical Urology

摘　　要：目的：比较回肠膀胱术中三种输尿管回肠吻合方式,探讨改良输尿管回肠吻合术的临床应用价值。方法：回顾性分析117例行全膀胱切除＋回肠膀胱术膀胱癌患者的临床资料,根据术中输尿管回肠吻合方式的不同分为三组：A组输尿管-回肠端侧吻合,44例88侧;B组输尿管-回肠端侧插入,37例74侧;C组输尿管回肠端端插入（改良组）,36例72侧。收集三组患者的临床资料,根据Clavien-Dindo分级系统对术后并发症进行分级,分析三种吻合方式术后90天内并发症发生情况。结果：三组患者手术均顺利完成。三组患者比较术后90天内并发症发生率,差异有统计学意义（P〈0.01）,C组的并发症发生率最低。轻度并发症（Ⅰ-Ⅱ级）,C组较A组和B组发生率差异无统计学意义（P〉0.05）;重度并发症（Ⅲ-Ⅴ级）和输尿管漏尿和狭窄的发生率,C组均较A组和B组显著降低,差异有统计学意义（P〈0.01）。结论：改良输尿管回肠膀胱吻合可有效降低术后并发症发生率,减少吻合口狭窄、漏尿,提高患者术后生活质量,是一种简单有效的输尿管肠管吻合方法。Objective： To compare three types of ureteroileal anastomosis technique in ileal conduit urinary divertion after radical cystectomy and to explore the clinical value of this modified technique. Method： The clinical data of 117 patients treated with radical cystectomy and ileal conduit urinary divertion in our center were retrospectively reviewed. All patients were divideded into A, B, and C group according to the different technique of uret-eroileal anastomosis. Group A include 44 patients （88 sides） underwent ureteroileal end-to-side anastomosis. Group B including 37 patients （74 sides） received ureteroileal end-to-side insertion. Group C including 36 patients （72 sides） were treat with modified ureteroileal end-to-side anastomosis. The clinical data of all patiens were collected. Early （90 day） postoperative complications were recorded and graded according to Clavien-Dindo classifica- tion system. Result; All operations were successfully completed. The overall complication rates among three groups were statistically different （ P 〈0.01）. Group C showed the lowest rate. There was no significant difference among three groups of grade I-II complication rates （ P 〉0.05）. However, the group C was the lowest in the incidence of grade III-V complications, compared with group A and B（ P 〈0.01）. Moreover, group C can reduce the occurrence rate of ureteral stricture and urinary leakage significantly（ P 〈0.01）. Conclusion.. Our modified ureteroileal anastomosis technique was simple and effective, which can reduce the complication rates, decrease the occurrence rate of ureteral stricture and urinary leakage, and improve the postoperative quality of life. So it might be a good option for ureter-ileal conduit anastomosis.

关 键 词：回肠膀胱术 输尿管回肠吻合 并发症 Clavien-Dindo分级 

分 类 号：R699.5[医药卫生—泌尿科学]