根治性膀胱切除术后改良田口法与布里克输尿管再植技术的比较。

Comparison of modified Taguchi and Bricker ureteral reimplantation techniques after radical cystectomy.

作者信息

Lee Cheryl T, Chen Bert T, Gong Edward, Hafez Khaled S, Sheffield Jacqueline H, Montie James E

机构信息

Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.

出版信息

Urology. 2004 Nov;64(5):940-4. doi: 10.1016/j.urology.2004.07.005.

DOI:10.1016/j.urology.2004.07.005

PMID:15533482

Abstract

OBJECTIVES

To present our experience with the modified Taguchi "single-stitch" ureteral reimplantation technique in patients undergoing radical cystectomy with urinary diversion compared with a traditional Bricker reimplantation technique. Improved techniques are continually sought for ureteroenteric anastomoses during urinary diversion. The modified Taguchi "single-stitch" ureteral reimplantation is reportedly a time-efficient technique that preserves anastomotic integrity.

METHODS

We retrospectively examined 75 consecutive patients with bladder cancer who underwent cystectomy and urinary diversion between October 1, 1999 and March 31, 2001. The ureteroenteric anastomosis was performed using a reinforced single-stitch modified Taguchi technique in the first 36 patients and an interrupted two-layer Bricker technique in the subsequent 39 patients during the creation of 47 orthotopic neobladders and 28 ileal conduit diversions. Ureteral stents were not routinely used. The demographic and perioperative clinical parameters were evaluated in each cohort, with particular attention to ureteral complications.

RESULTS

Modified Taguchi and Bricker ureteral anastomoses were performed in 48% and 52% of patients, respectively. Patient age, sex, and body mass indexes were similar between groups. Apart from pathologic stage, univariate analysis did not demonstrate statistically significant differences between the groups in the demographic, intraoperative (estimated blood loss, diversion type, operative time) or postoperative (length of stay, rate of complications) parameters. Ureteral complications occurred in 8% of the Bricker group and 15% of the modified Taguchi group (P = 0.23).

CONCLUSIONS

Either technique can be performed safely and in a timely fashion. However, the increased number of ureteral leaks in the modified Taguchi cohort combined with no advantage in procedure time, prompted our return to the Bricker technique exclusively.

摘要

目的

介绍我们在接受根治性膀胱切除术并行尿流改道的患者中应用改良田口“单针法”输尿管再植技术的经验，并与传统的布里克再植技术进行比较。在尿流改道过程中，人们一直在寻求改进输尿管肠吻合术的技术。据报道，改良田口“单针法”输尿管再植术是一种节省时间的技术，可保持吻合口的完整性。

方法

我们回顾性研究了1999年10月1日至2001年3月31日期间连续75例接受膀胱切除术和尿流改道的膀胱癌患者。在前36例患者中，在创建47个原位新膀胱和28个回肠导管改道时，采用强化单针法改良田口技术进行输尿管肠吻合，在随后的39例患者中采用间断两层布里克技术。未常规使用输尿管支架。对每个队列的人口统计学和围手术期临床参数进行评估，特别关注输尿管并发症。

结果

分别有48%和52%的患者接受了改良田口和布里克输尿管吻合术。两组患者的年龄、性别和体重指数相似。除病理分期外，单因素分析未显示两组在人口统计学、术中（估计失血量、改道类型、手术时间）或术后（住院时间、并发症发生率）参数方面存在统计学显著差异。布里克组输尿管并发症发生率为8%，改良田口组为15%（P = 0.23）。