输尿管皮肤造口术-皮瓣嵌入法用于根治性膀胱切除术+尿流改道术10例效果初探  

Efficacy of cutaneous ureterostomy-flap embedding in radical cystectomy plus urinary diversion in 10 cases

作　　者：于徐锋 花梅免[1] 曾蜀雄[1] 陈庆 王子威 应毅蝶 王茂宇 张晨[1] 王益 许传亮[1] YU Xufeng;HUA Meimian;ZENG Shuxiong;CHEN Qing;WANG Ziwei;YING Yidie;WANG Maoyu;ZHANG Chen;WANG Yi;XU Chuanliang(Department of Urology,Shanghai Changhai Hospital,Shanghai 200433,China)

机构地区：[1]上海长海医院泌尿外科,上海200433

出　　处：《现代泌尿外科杂志》2024年第12期1099-1103,共5页Journal of Modern Urology

基　　金：国家自然科学基金项目(No.81972391);上海市科学技术委员会基金项目(No.20Y11904800)。

摘　　要：目的探讨输尿管皮肤造口术-皮瓣嵌入法在根治性膀胱切除术+尿流改道术中的临床应用效果。方法纳入2023年2月—5月于上海长海医院泌尿外科行根治性膀胱切除术+尿流改道术的10例膀胱癌患者的临床资料,尿流改道采用输尿管皮肤造口术-皮瓣嵌入法。分析患者术后1年内的造口无管率和造口狭窄率,术前1 d与术后1年内肾功能指标差异和术后6个月内尿流改道相关并发症,包括肾积水、尿路感染、肾结石等。结果10例患者手术均顺利完成,术前1 d与术后1年内肾功能指标无明显差异(P>0.05)。术后6个月,1例患者出现肾结石,经手术治疗后痊愈;2例患者出现尿路感染,予以抗生素治疗后痊愈;2例患者出现单侧轻度肾积水,予保守治疗后缓解。术后1年内造口无管率为80%(8/10),并且拔管后未出现肾积水加重等输尿管梗阻现象,置管时间97~211(151.63±42.47)d。有2例患者未能在1年内拔除输尿管支架,造口狭窄率为20%(2/10)。结论在根治性膀胱切除+尿流改道术中应用皮瓣嵌入法操作简单安全,术后并发症较少,拔管成功率较高,效果良好。Objective To explore the clinical application of cutaneous ureterostomy-flap embedding in radical cystectomy plus urinary diversion.Methods The clinical data of 10 patients with bladder cancer treated with this method in our hospital during Feb.and May 2023 were involved.Cutaneous ureterostomy-flap embedding was used in urinary diversion.The stoma-free rate and stenosis rate of stomas within 1 year postoperatively,differences in renal function indicators 1 day before operation and 1 year after operation,urinary diversion-related complications within 6 months postoperatively,including hydronephrosis,urinary tract infections,renal stones were analyzed.Results All surgeries were successfully completed.At 1 year postoperatively,renal function indicators showed no significant difference compared to preoperative levels(P>0.05).At 6 months postoperatively,1 patient developed renal stones,successfully treated with surgery;2 had urinary tract infection,recovered after antibiotic treatment;2 had mild unilateral hydronephrosis,alleviated with conservative management.At 1 year postoperatively,the catheter-free rate was 80%(8/10),with no worsening of hydronephrosis or occurrence of ureteral obstruction,and the stent placement duration ranged from 97 to 211 days,average(151.63±42.47)days.The ureteral stent was not removed in 2 patients within 1 year,so the stoma stenosis rate was 20%(2/10).Conclusion The application of flap embedding in urinary diversion following radical cystectomy is a simple and safe procedure,with few postoperative complications,high success rate of stent removal,and overall favorable outcomes.

关 键 词：膀胱癌 尿流改道术 输尿管皮肤造口术 改良手术 皮瓣嵌入法 

分 类 号：R737.14[医药卫生—肿瘤]