Hautmann S, Chun K H F, Currlin E, Braun P, Huland H, Juenemann K P
Department of Urology, University Hospital Hamburg Eppendorf, Hamburg, Germany.
J Urol. 2006 Apr;175(4):1389-93; discussion 1393-4. doi: 10.1016/S0022-5347(05)00709-3.
Radical cystectomy and various techniques of urinary diversion are gold standard treatments for invasive bladder cancer. However, postoperative hydronephrosis is a common complication in these patients. A special focus was placed on the type of ureteroileal anastomosis used with 2 different techniques performed at 1 institution.
Between 1995 and 2003 a total of 106 consecutive patients with bladder cancer underwent cystectomy followed by construction of an ileal neobladder. The nonrefluxing technique of ureter tunneling described by LeDuc and the refluxing chimney technique used for ureter implantation into the ileum-neobladder were compared. Hydronephrosis due to ureteral strictures was studied immediately following surgery and up to 5 years after surgery.
A total of 204 RU were included in the study. The LeDuc technique was used in 132 RU (64%) and the chimney technique was used in 72 RU (36%). Hydronephrosis rate of 2% were found in each of the 2 groups after 5 years of followup.
Postoperative hydronephrosis due to ureteral strictures is observed at the same rate during long-term followup with the LeDuc and chimney techniques. We favor the chimney technique compared to the LeDuc tunnel due to easier technical preparation and a better chance to identify the ureters endoscopically at a later time. The chimney does give extra length to reach the ureteral stump, especially in cases of distal ureteral carcinoma in situ.
根治性膀胱切除术及多种尿流改道技术是浸润性膀胱癌的金标准治疗方法。然而，术后肾积水是这些患者的常见并发症。本研究特别关注了在一家机构采用两种不同技术时所使用的输尿管回肠吻合术的类型。
1995年至2003年间，共有106例连续性膀胱癌患者接受了膀胱切除术，随后构建了回肠新膀胱。比较了LeDuc描述的输尿管隧道抗反流技术和用于输尿管植入回肠新膀胱的反流烟囱技术。对术后即刻及术后长达5年因输尿管狭窄导致的肾积水进行了研究。
本研究共纳入204条输尿管。132条输尿管（64%）采用了LeDuc技术，72条输尿管（36%）采用了烟囱技术。随访5年后，两组的肾积水发生率均为2%。
在长期随访中，LeDuc技术和烟囱技术导致输尿管狭窄引起的术后肾积水发生率相同。与LeDuc隧道技术相比，我们更倾向于烟囱技术，因为其技术准备更简便，且后期通过内镜识别输尿管的机会更大。烟囱技术确实能提供额外的长度以到达输尿管残端，尤其是在输尿管远端原位癌的情况下。
