Department of Urology, Mayo Medical School, Rochester, MN, USA.
BJU Int. 2010 Mar;105(6):860-3. doi: 10.1111/j.1464-410X.2009.08811.x. Epub 2009 Aug 13.
Therapy (case series).
To examine our long-term experience with ureterosigmoidostomy (USS) to evaluate its potential applicability in the treatment of benign and malignant conditions of the urinary bladder, as USS has been largely disregarded recently, secondary to concerns of long-term complications, but has had a resurgence of interest due to its potential applicability to newer minimally invasive surgical techniques.
We identified 51 patients who had USS from 1956 to 2006 at our institution and with >10 years of follow-up. The patients were followed retrospectively by a chart review. Patient data were analysed in a multifaceted fashion, paying particular attention to metabolic abnormalities, early (< or =30 days) and late (>30 days) complication rates, continence rates, imaging changes, and the rate of repeat surgical intervention.
The median (range) follow-up was 15.7 (10.0-45.4) years and the median age at surgery was 58.8 (0.4-79.0) years; 40 (79%) patients had the procedure for malignancy and 11 (22%) for benign disease. Six patients (12%) had at least one early complication, including one wound dehiscence and one pulmonary embolus. In all, 22 patients (43%) had at least one late complication, with anastomotic stricture being the most common (11/51, 22%). This was followed by recurrent pyelonephritis in eight patients (16%), stones in five (10%), chronic renal insufficiency in three (6%) and severe intractable acidosis in two (4%). A repeat surgical intervention was required in 19 (37%) patients. In all, 94% (48) reported complete continence. No patient developed colonic malignancy during the course of this study.
USS is associated with long-term complications. While this complication rate might not be acceptable for all patients, some might be willing to undergo the procedure as the primary method of urinary diversion. When designing newer minimally invasive techniques for the treatment of benign and malignant conditions of the bladder, consideration could be given to USS as a form of urinary diversion in highly selected patients.
治疗（病例系列）。
4。
检查我们在输尿管乙状结肠吻合术（USS）方面的长期经验，以评估其在治疗良性和恶性膀胱疾病中的潜在适用性，因为最近由于对长期并发症的担忧，USS 已被大量忽视，但由于其对新的微创外科技术的潜在适用性，它重新引起了人们的兴趣。
我们在本院确定了 51 名 1956 年至 2006 年间接受 USS 治疗且随访时间>10 年的患者。通过病历回顾对患者进行回顾性随访。对患者数据进行多方面分析，特别注意代谢异常、早期（≤30 天）和晚期（>30 天）并发症发生率、控尿率、影像学变化和再次手术干预率。
中位（范围）随访时间为 15.7（10.0-45.4）年，中位手术年龄为 58.8（0.4-79.0）岁；40（79%）例患者因恶性疾病接受该手术，11（22%）例因良性疾病接受该手术。6 名患者（12%）至少有一次早期并发症，包括 1 例伤口裂开和 1 例肺栓塞。共有 22 名患者（43%）至少有一次晚期并发症，吻合口狭窄最常见（51 例中有 11 例，22%）。其次是 8 例（16%）复发性肾盂肾炎、5 例（10%）结石、3 例（6%）慢性肾功能不全和 2 例（4%）严重难治性酸中毒。19 名患者（37%）需要再次手术干预。共有 94%（48 例）患者报告完全控尿。在本研究过程中，没有患者发生结直肠恶性肿瘤。
USS 与长期并发症相关。虽然这种并发症发生率可能不被所有患者接受，但有些患者可能愿意接受该手术作为主要的尿流改道术。在为治疗良性和恶性膀胱疾病设计新的微创技术时，可以考虑将 USS 作为一种高度选择患者的尿流改道术。
