Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Urology. 2011 Nov;78(5):1191-5. doi: 10.1016/j.urology.2011.07.001. Epub 2011 Sep 3.
Up to 10% of patients who have undergone the Bricker ileal conduit urinary diversion may develop ureteroileal anastomotic complications that are more frequently associated with the left side ureter. We have therefore modified the standard Bricker ileal conduit technique to minimize the anastomotic complications associated with the left side ureter.
In our modification, the proximate end of the ileal conduit was brought from the right side to the left under the mesosigmoid in an isoperistaltic fashion. The left ureter that remained in the natural extraperitoneal location was anastomosed to the ileal segment in the usual end-to-side fashion without the need of extensive ureteral dissection.
A series of 42 patients have undergone ileal conduit urinary diversion using this modified technique. During a median follow-up period of 18.6 months, this technique was found to have no associated major perioperative complications and early- and intermediate-term ureteroileal anastomotic complications from both sides of the ureters.
Our modified ileal conduit diversion technique was easy and safe to perform, and may serve as an alternative technique for the standard Bricker ileal conduit urinary diversion, especially when the left distal ureter was involved extensively with urothelial carcinoma.
行 Bricker 回肠膀胱尿流改道术的患者中，多达 10%可能出现输尿管-肠吻合口并发症，且左侧输尿管更常发生此类并发症。因此，我们改良了标准 Bricker 回肠膀胱术式，以最大程度减少与左侧输尿管相关的吻合口并发症。
改良方法为，将回肠膀胱的近端从右侧移至系膜下的左侧，以逆蠕动方式进行。左侧保持在自然腹膜外位置的输尿管与回肠段以通常的端侧吻合方式吻合，无需广泛的输尿管游离。
42 例患者采用该改良技术行回肠膀胱尿流改道术。中位随访 18.6 个月期间，该技术未出现与手术相关的严重并发症，两侧输尿管的早期和中期输尿管-肠吻合口并发症发生率均较低。
我们改良的回肠膀胱转流术操作简单、安全，可能成为标准 Bricker 回肠膀胱尿流改道术的替代技术，尤其是当左侧远端输尿管广泛累及尿路上皮癌时。
