Department of Urology, Roswell Park Cancer Institute, Buffalo, New York; Department of Urology, Cairo University, Cairo, Egypt.
Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
J Urol. 2018 Mar;199(3):766-773. doi: 10.1016/j.juro.2017.08.112. Epub 2017 Sep 7.
We investigated the prevalence of and variables associated with parastomal hernia and its outcomes after robot-assisted radical cystectomy and ileal conduit creation for bladder cancer.
We retrospectively reviewed the records of patients who underwent robot-assisted radical cystectomy at our institution. Parastomal hernia was defined as the protrusion of abdominal contents through the stomal defect in the abdominal wall on cross-sectional imaging. Parastomal hernia was further described in terms of patient and hernia characteristics, symptoms, management and outcomes. The Kaplan-Meier method was used to determine time to parastomal hernia and time to surgery. Multivariate stepwise logistic regression was done to evaluate variables associated with parastomal hernia.
A total of 383 patients underwent robot-assisted radical cystectomy and ileal conduit creation. Of the patients 75 (20%) had parastomal hernia, which was symptomatic in 23 (31%), and 11 (15%) underwent treatment. Median time to parastomal hernia was 13 months (IQR 9-22). Parastomal hernia developed in 9%, 23% and 32% of cases at 1, 2 and 3 years, respectively. Patients with parastomal hernia had a significantly higher body mass index (30 vs 28 kg/m, p = 0.02), longer overall operative time (357 vs 340 minutes, p = 0.01) and greater blood loss (325 vs 250 ml, p = 0.04). On multivariate analysis operative time (OR 1.25, 95% CI 1.21-3.90, p <0.001), a fascial defect 30 mm or greater (OR 5.23, 95% CI 2.32-11.8, p <0.001) and a lower postoperative estimated glomerular filtration rate (OR 2.17, 95% CI 1.21-3.90, p = 0.01) were significantly associated with parastomal hernia.
Symptoms develop in approximately a third of patients with parastomal hernia and 15% will require surgery. The risk of parastomal hernia plateaued after postoperative year 3. Longer operative time, a larger fascial defect and lower postoperative kidney function were associated with parastomal hernia.
我们研究了机器人辅助根治性膀胱切除术和回肠导管造口术治疗膀胱癌后发生粪瘘的流行情况和相关变量及其结局。
我们回顾性分析了在我院接受机器人辅助根治性膀胱切除术的患者记录。粪瘘定义为腹壁切口处的腹部内容物通过横断面上的肠造口缺陷突出。粪瘘进一步描述了患者和疝的特征、症状、管理和结果。采用 Kaplan-Meier 法确定粪瘘和手术时间。多变量逐步逻辑回归用于评估与粪瘘相关的变量。
共 383 例患者接受机器人辅助根治性膀胱切除术和回肠导管造口术。75 例（20%）患者有粪瘘，其中 23 例（31%）有症状，11 例（15%）接受治疗。中位粪瘘时间为 13 个月（IQR 9-22）。1 年、2 年和 3 年分别有 9%、23%和 32%的患者发生粪瘘。有粪瘘的患者体重指数明显较高（30 vs 28 kg/m，p = 0.02），总手术时间较长（357 vs 340 分钟，p = 0.01），出血量较大（325 vs 250 ml，p = 0.04）。多变量分析显示，手术时间（OR 1.25，95%CI 1.21-3.90，p <0.001）、筋膜缺损 30mm 或更大（OR 5.23，95%CI 2.32-11.8，p <0.001）和术后估算肾小球滤过率较低（OR 2.17，95%CI 1.21-3.90，p = 0.01）与粪瘘显著相关。
大约三分之一的粪瘘患者出现症状，15%的患者需要手术。粪瘘的风险在术后 3 年后趋于稳定。较长的手术时间、较大的筋膜缺损和较低的术后肾功能与粪瘘有关。
