回肠膀胱术的腹膜外操作可减少膀胱切除术后回肠膀胱术转流引起的造口旁疝。

Extraperitonealization of ileal conduit reduces parastomal hernia after cystectomy and ileal conduit diversion.

作者信息

Li Zhiyong, Zhang Zhiling, Ma Huali, Yao Kai, Qin Zike, Han Hui, Ye Yunlin, Li Yonghong, Dong Pei, Jiang Lijuan, Tian Li, Liu Zhuowei, Zhou Fangjian

机构信息

Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, P. R. China; Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.

Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in Southern China, Collaborative Innovation Center for Cancer Medicine Guangzhou, P. R. China; Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China.

出版信息

Urol Oncol. 2022 Apr;40(4):162.e17-162.e23. doi: 10.1016/j.urolonc.2021.11.022. Epub 2021 Dec 15.

DOI:10.1016/j.urolonc.2021.11.022

PMID:34920945

Abstract

OBJECTIVE

Parastomal hernia (PSH) is a common complication of ileal conduit diversion after radical cystectomy. Novel surgical techniques for preventing PSH formation are needed. We aimed to evaluate surgical technique of extraperitonealizing the ileal conduit (modified ileal conduit) for preventing PSH.

METHODS

A retrospective analysis of 375 consecutive patients who underwent ileal conduit after cystectomy at the Sun Yat-sen University Cancer Center between January 1, 2000 and June 31, 2019 was conducted. 214 patients had modified ileal conduit diversion and 161 patients conventional ileal conduit (Bricker) diversion. The demographic and clinicopathologic characteristics of patients in the 2 groups were compared using the t test and Chi square test. Univariable and multivariable Cox regression analyses were used to predict the risk of PSH formation.

RESULTS

The 2 groups were comparable in regard to all demographic and clinicopathologic variables. The incidence of PSH diagnosed by CT scan was 7.5% in the modified group and 21.1% in the conventional group (P < 0.001). High BMI and history of prior abdominal surgery was identified by univariable analysis as risk factors of PSH formation. Multivariable analyses revealed that technique of extraperitonealizing ileal conduit significantly reduced incidence of PSH in patients with or without risk factors of PSH formation (OR = 0.29, 95% CI 0.16-0.54, P < 0.001).

CONCLUSIONS

Technique of extraperitonealizing ileal conduit appeared to be effective in reducing PSH formation after ileal conduit diversion.

摘要

目的

造口旁疝（PSH）是根治性膀胱切除术后回肠代膀胱术的常见并发症。需要新的预防PSH形成的手术技术。我们旨在评估将回肠代膀胱术腹膜外化（改良回肠代膀胱术）预防PSH的手术技术。

方法

对2000年1月1日至2019年6月31日在中山大学肿瘤防治中心连续375例行膀胱切除术后行回肠代膀胱术的患者进行回顾性分析。214例患者行改良回肠代膀胱术，161例患者行传统回肠代膀胱术（Bricker术）。采用t检验和卡方检验比较两组患者的人口统计学和临床病理特征。采用单变量和多变量Cox回归分析预测PSH形成的风险。

结果

两组在所有人口统计学和临床病理变量方面具有可比性。CT扫描诊断的PSH发生率在改良组为7.5%，在传统组为21.1%（P<0.001）。单变量分析确定高体重指数和既往腹部手术史为PSH形成的危险因素。多变量分析显示，回肠代膀胱术腹膜外化技术显著降低了有或无PSH形成危险因素患者的PSH发生率（OR=0.29，95%CI 0.16-0.54，P<0.001）。