Ramirez Pedro T, Modesitt Susan C, Morris Mitchell, Edwards Creighton L, Bevers Michael W, Wharton J Taylor, Wolf Judith K
Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Gynecol Oncol. 2002 May;85(2):285-91. doi: 10.1006/gyno.2002.6594.
The purpose of this study was to review our experience with continent urinary diversions in patients with gynecologic malignancies and evaluate the presentation and management of early and late complications.
A retrospective chart review was performed of all patients who underwent a continent urinary diversion on the Gynecologic Oncology Service at The University of Texas M. D. Anderson Cancer Center during the period January 1988 to March 2001. We analyzed our data to evaluate potential risk factors for complications. Renal status, conduit integrity, and overall patient outcomes were also studied.
We identified 40 patients who underwent a continent urinary diversion using an ileocolonic segment (Miami pouch technique). All patients had a history of gynecologic malignancies. The median age at the time of the procedure was 50 years (range 24 to 76 years), and the median weight was 69.6 kg (range 47 to 125 kg). A total of 39 patients (98%) had a history of radiotherapy. Continent urinary diversion was performed as part of an anterior pelvic exenteration in 12 patients (30%), in conjunction with a total pelvic exenteration in 18 patients (45%), and as the main procedure in 10 patients (25%). The median estimated blood loss was 2100 ml (range 200 to 8500 ml). The median length of hospitalization was 19.5 days (range 7 to 56 days). A total of 24 patients (60.0%) had a postoperative complications unrelated to the reservoir. Complications directly related to the continent urinary diversion were seen in 26 (65.0%) of 40 patients. None of the patients in this study group developed chronic renal failure, and there were no perioperative deaths. At last evaluation, 36 (90%) of 40 patients reported normal continent conduit function.
Continent urinary diversion using an ileocolonic segment is a reasonable alternative to the ileal and transverse colon conduit in bladder reconstruction in patients undergoing radical pelvic surgery. The routine use of postoperative total parenteral nutrition, the chronic use of antibiotics after discharge from the hospital, and the routine use of imaging studies remain controversial. In this group of patients, the majority of complications may be successfully managed conservatively.
本研究旨在回顾我们在妇科恶性肿瘤患者中行可控性尿流改道术的经验，并评估早期和晚期并发症的表现及处理方法。
对1988年1月至2001年3月期间在德克萨斯大学MD安德森癌症中心妇科肿瘤服务部接受可控性尿流改道术的所有患者进行回顾性病历审查。我们分析数据以评估并发症的潜在危险因素。还研究了肾脏状况、导管完整性和患者总体预后。
我们确定了40例行回结肠段可控性尿流改道术（迈阿密袋技术）的患者。所有患者均有妇科恶性肿瘤病史。手术时的中位年龄为50岁（范围24至76岁），中位体重为69.6kg（范围47至125kg）。共有39例患者（98%）有放疗史。12例患者（30%）的可控性尿流改道术作为前盆腔脏器清除术的一部分进行，18例患者（45%）与全盆腔脏器清除术联合进行，10例患者（25%）作为主要手术进行。估计中位失血量为2100ml（范围200至8500ml）。中位住院时间为19.5天（范围7至56天）。共有24例患者（60.0%）发生与贮尿囊无关的术后并发症。40例患者中有26例（65.0%）出现与可控性尿流改道术直接相关的并发症。该研究组中无患者发生慢性肾衰竭，且无围手术期死亡。在最后一次评估时，40例患者中有36例（90%）报告可控性导管功能正常。
对于接受根治性盆腔手术的患者，采用回结肠段进行可控性尿流改道术是膀胱重建中回肠和横结肠导管的合理替代方案。术后常规使用全胃肠外营养、出院后长期使用抗生素以及常规使用影像学检查仍存在争议。在这组患者中，大多数并发症可通过保守治疗成功处理。
