Jeong In Gab, Han Kyung-Sik, Park Sang Hyun, Song Sang Hoon, Song Geehyun, Park Hyung Keun, Choo Myung-Soo, Hong Bumsik
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Ann Surg Oncol. 2016 May;23(5):1646-52. doi: 10.1245/s10434-015-5032-z. Epub 2015 Dec 29.
This study reviewed the outcomes for patients who underwent simultaneous bladder and ureter reconstructive surgery using the ileum after radical treatment for cervical cancer.
The medical records of seven patients who underwent augmentation ileocystoplasty with ileal ureter replacement between September 2006 and May 2013 were reviewed. Data on indications for surgery, underlying urologic comorbidities, type of ureteral replacement, postoperative complications, and changes in renal function were obtained.
The median age of the patients was 56 years. The primary tumor was cervical cancer in all the patients, and the majority of the patients (4/7, 57.1 %) were previously treated with radical hysterectomy plus radiotherapy. Ileal ureter replacement was performed on 11 renal units, and bilateral ileal ureter substitution was performed for four patients, with the largest ureteral defect being 15 cm. The median length of the ileum used for augmentation and ureter substitution was 30 cm (range 15-40 cm), and the median hospital stay was 23 days (range 18-47 days). The overall rate of major complications (grade ≥3) was 57.1 % (4 of 7 patients). The median preoperative and immediate postoperative serum creatinine levels were respectively 1.2 mg/dL and 0.9 mg/dL. During a mean follow-up duration of 38 months, none of the patients experienced deterioration of renal function after surgery.
Ileal ureter substitution combined with augmentation ileocystoplasty is a useful surgical technique for bridging long ureteral defects caused by ureteric stenosis from surgery, radiotherapy, or both for pelvic tumors in contracted low-compliance bladders.
本研究回顾了宫颈癌根治性治疗后使用回肠进行膀胱和输尿管同期重建手术患者的治疗结果。
回顾了2006年9月至2013年5月期间7例行回肠扩大膀胱成形术并置换回肠输尿管患者的病历。获取了手术指征、潜在泌尿系统合并症、输尿管置换类型、术后并发症及肾功能变化等数据。
患者的中位年龄为56岁。所有患者的原发肿瘤均为宫颈癌，大多数患者（4/7，57.1%）曾接受根治性子宫切除术加放疗。对11个肾单位进行了回肠输尿管置换，4例患者进行了双侧回肠输尿管置换，最大输尿管缺损为15cm。用于扩大和输尿管置换的回肠中位长度为30cm（范围15 - 40cm），中位住院时间为23天（范围18 - 47天）。主要并发症（≥3级）的总体发生率为57.1%（7例患者中的4例）。术前和术后即刻血清肌酐水平的中位数分别为1.2mg/dL和0.9mg/dL。在平均38个月的随访期间，术后无患者出现肾功能恶化。
回肠输尿管置换联合回肠扩大膀胱成形术是一种有用的手术技术，可用于修复因手术、放疗或两者导致的盆腔肿瘤引起的输尿管狭窄所致的长段输尿管缺损，适用于收缩性低顺应性膀胱。
