Msezane Lambda, Reynolds W Stuart, Mhapsekar Rishi, Gerber Glenn, Steinberg Gary
Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA.
J Urol. 2008 Apr;179(4):1428-31. doi: 10.1016/j.juro.2007.11.083. Epub 2008 Mar 4.
Open surgery after cystectomy can be a challenge. We report the incidence of postoperative urinary diversion-enteric fistula and ureteral strictures in patients undergoing radical cystectomy, and discuss the diagnosis and management of these complications, including our surgical approach to these patients.
We preformed a retrospective review of 553 patients undergoing radical cystectomy and urinary diversion for bladder cancer between April 1999 and January 2007. Patients in whom a ureteral stricture or fistula developed were identified by serial laboratory and imaging evaluations. A chart review was preformed to identify symptoms, time to stricture or fistula development, radiological findings, type of diversion, estimated blood loss and whether the original anastomosis was stented. Management and outcomes were assessed.
Of 553 patients reviewed ureteral stricture developed in 41 (7.4%) with a mean followup of 20.2 months (range 1 to 98). Strictures developed in 11% (31 of 272) of the orthotopic ileal neobladder, 2.5% (6 of 236) of ileal conduit and 8% (4 of 45) of Indiana pouch cases. Open repair led to an overall success rate of 87%. Urinary diversion-enteric fistula developed in 12 (2.2%) of the 553 patients with a mean followup of 28.4 months (range 3 to 94), all of whom had undergone orthotopic neobladder diversion. No patient had recurrence after surgical repair of the fistula.
Open revision remains the gold standard management for ureteral strictures and urinary diversion-enteric fistulas occurring after radical cystectomy. The addition of the chimney modification to the orthotopic neobladder facilitates surgical repair.
膀胱切除术后的开放手术可能具有挑战性。我们报告了接受根治性膀胱切除术患者术后尿流改道-肠瘘和输尿管狭窄的发生率，并讨论这些并发症的诊断和管理，包括我们对这些患者的手术方法。
我们对1999年4月至2007年1月期间接受根治性膀胱切除术及膀胱癌尿流改道的553例患者进行了回顾性研究。通过系列实验室和影像学评估确定发生输尿管狭窄或瘘的患者。进行病历审查以确定症状、狭窄或瘘形成的时间、影像学表现、改道类型、估计失血量以及原吻合口是否放置支架。评估管理措施和结果。
在553例接受评估的患者中，41例（7.4%）发生输尿管狭窄，平均随访20.2个月（范围1至98个月）。原位回肠新膀胱患者中11%（272例中的31例）发生狭窄，回肠导管患者中2.5%（236例中的6例）发生狭窄，印第安纳袋患者中8%（45例中的4例）发生狭窄。开放修复的总体成功率为87%。553例患者中有12例（2.2%）发生尿流改道-肠瘘，平均随访28.4个月（范围3至94个月），所有这些患者均接受了原位新膀胱改道。瘘修补术后无患者复发。
开放修复仍然是根治性膀胱切除术后发生输尿管狭窄和尿流改道-肠瘘的金标准治疗方法。原位新膀胱增加烟囱改良有助于手术修复。
