National Cancer Institute, Kyiv 03022, Ukraine.
Exp Oncol. 2020 Sep;42(3):224-227. doi: 10.32471/exp-oncology.2312-8852.vol-42-no-3.15047.
Radical cystectomy (RC) has been used for over 100 years as an effective treatment of muscle invasive bladder cancer (MIBC). However, the main surgical challenge is not only to remove an affected organ but also to replace its functional component - urine diversion. The aim of our work is to study the efficacy of the modified ureterocutaneostomy technique by estimating the quality of life in post-RC patients with MIBC.
A retrospective analysis of the cases of 40 patients was provided. Two groups were delineated depending on urinary diversion: 20 patients with urinary derivation by the modified ureterocutaneostomy method, and 20 patients - with Bricker conduit. All patients were matched by mean age, gender, American Society of Anesthesiologists status, disease stage and duration. 16 (80%) and 15 (75%) patients from the study and control groups, respectively, passed 3 courses of standard preoperative polychemotherapy with gemcitabine-cisplatin. Quality of life was assessed using the health survey SF-36 form (developed at the US Medical Research Institute), adapted at the National Cancer Institute (Ukraine).
Comparing patients after ureterocutaneostomy or Bricker surgery, no statistical discrepancy was noted before surgery and after 3 months. A statistical difference in perioperative parameters was noted only when comparing the surgery duration and length of stay in hospital.
The modified ureterocutaneostomy technique contributes to performing surgery faster and more effectively since an intestinal stage is skipped in surgery. Our findings indicate that ureterocutaneostomy technique may be used as a standard of care for post-RC patients with MIBC.
根治性膀胱切除术（RC）作为肌层浸润性膀胱癌（MIBC）的有效治疗方法已经使用了 100 多年。然而，主要的手术挑战不仅在于切除受影响的器官，还在于取代其功能成分——尿流改道。我们的工作旨在通过评估 MIBC 根治性膀胱切除术后患者的生活质量来研究改良输尿管皮造口术的疗效。
对 40 例患者的病例进行回顾性分析。根据尿流改道方式将患者分为两组：20 例采用改良输尿管皮造口术，20 例采用 Bricker 导管。所有患者按平均年龄、性别、美国麻醉医师协会状态、疾病分期和持续时间进行匹配。研究组和对照组分别有 16 例（80%）和 15 例（75%）患者接受了 3 个疗程的吉西他滨顺铂标准术前化疗。生活质量采用健康调查 SF-36 表（由美国医学研究所开发）进行评估，该表已在乌克兰国家癌症研究所进行了改编。
比较输尿管皮造口术或 Bricker 手术后的患者，手术前和手术后 3 个月没有统计学差异。只有在比较手术持续时间和住院时间时，才注意到围手术期参数存在统计学差异。
改良输尿管皮造口术技术可更快、更有效地进行手术，因为手术中跳过了肠道阶段。我们的发现表明，输尿管皮造口术技术可作为 MIBC 根治性膀胱切除术后患者的标准治疗方法。
