Kouba Erik, Sands Matt, Lentz Aaron, Wallen Eric, Pruthi Raj S
Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
J Urol. 2007 Sep;178(3 Pt 1):950-4. doi: 10.1016/j.juro.2007.05.028. Epub 2007 Jul 16.
In this study we examined the incidence and associated factors of stomal complications in patients undergoing radical cystectomy with ileal conduit urinary diversion for bladder cancer. In addition, we evaluated the treatment and outcomes of surgical procedures in patients in whom stoma related complications developed.
From 2001 to 2005 a total of 137 patients underwent ileal conduit diversion after cystectomy or exploration for bladder cancer, had complete clinical followup and were followed for at least 12 months after surgery. The incidence of stomal complications (including parastomal hernia, stomal stenosis and stomal prolapse) is reported with correlations made to age, race, gender, body mass index, smoking history, alcohol consumption, preoperative laboratory values (creatinine, hematocrit), operative estimated blood loss and surgical complications. In addition, management of stomal complications is reported.
Of the 137 patients 21 stomal complications (15.3%) occurred in 20 patients (14.6%). The most common complication was parastomal hernia in 19 patients (13.9 %). Stomal stenosis developed in 1 patient (0.7%) and stomal prolapse developed in 1 patient with a parastomal hernia (0.7%). There were no significant differences in gender, age, race, preoperative laboratory values or history of abdominal/pelvic radiation therapy between patients with or without complications. However, patients in whom complications developed had a significantly higher mean body mass index compared to those without complications (30.8 vs 26.5 kg/m(2), respectively, p = 0.012). Operative outcomes, extent of disease and length of postoperative followup were also similar between patients with or without stomal complications. In addition, there were no significant differences in lifestyle factors (eg smoking, alcohol abuse) in patients in whom complications developed.
Stomal complications associated with ileal conduit urinary diversion are not uncommon and occur in almost 15% of patients, with the most common problem being parastomal hernia. Evaluation of possible risk factors demonstrates that obesity may be a contributing factor in the development of stomal complications, particularly in the elderly. Furthermore, our experience suggests that subsequent repairs of parastomal hernias are only moderately successful.
在本研究中，我们调查了因膀胱癌接受根治性膀胱切除术并采用回肠代膀胱术进行尿流改道的患者中造口并发症的发生率及相关因素。此外，我们评估了发生造口相关并发症的患者手术治疗方法及结果。
2001年至2005年期间，共有137例患者在膀胱切除术后或因膀胱癌探查后接受了回肠代膀胱术，均有完整的临床随访记录，且术后至少随访12个月。报告了造口并发症（包括造口旁疝、造口狭窄和造口脱垂）的发生率，并分析了其与年龄、种族、性别、体重指数、吸烟史、饮酒情况、术前实验室检查值（肌酐、血细胞比容）、手术估计失血量及手术并发症之间的相关性。此外，还报告了造口并发症的处理情况。
137例患者中，20例（14.6%）出现了21例造口并发症（15.3%）。最常见的并发症是19例（13.9%）患者发生造口旁疝。1例患者（0.7%）出现造口狭窄，1例合并造口旁疝的患者（0.7%）出现造口脱垂。有并发症和无并发症患者在性别、年龄、种族、术前实验室检查值或腹部/盆腔放疗史方面无显著差异。然而，发生并发症的患者平均体重指数显著高于无并发症患者（分别为30.8和26.5kg/m²，p = 0.012）。有造口并发症和无并发症患者的手术结果、疾病范围及术后随访时间也相似。此外，发生并发症患者的生活方式因素（如吸烟、酗酒）无显著差异。
与回肠代膀胱术相关的造口并发症并不少见，近15%的患者会出现，最常见的问题是造口旁疝。对可能的危险因素进行评估表明，肥胖可能是造口并发症发生的一个促成因素，尤其是在老年患者中。此外，我们的经验表明，后续造口旁疝修补术的成功率仅为中等。
