Department of Urology, Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 200032, People's Republic of China.
Department of Oncology, Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, People's Republic of China.
BMC Urol. 2022 Jul 27;22(1):116. doi: 10.1186/s12894-022-01073-w.
The need for the left ureter to pass through the subsigmoid during ileal conduit diversion surgery has not been investigated in any studies. A modified technique is simply used in the ileal conduit with the left ureter straight over the sigmoid colon due to the possible damage and lack of scientifically validated advantages of this procedure. Our study aimed to investigate the feasibility of the suggested surgical technique, as well as to evaluate perioperative outcomes and postoperative complications with a focus on the prevalence of small bowel obstruction (SBO) and ureteroileal anastomotic stricture (UAS).
A prospective single-center cohort of 84 consecutive patients undergoing laparoscopic radical cystectomy (LRC) and ileal conduit urinary diversion was conducted between January 2018 and April 2020. The incidence of SBO and UAS, perioperative outcomes, and postoperative complications were compared between a trial group of 30 patients receiving the modified procedure and a control group of 54 patients receiving the conventional Bricker ileal conduit.
The two groups were comparable concerning patient characteristics and clinicopathologic features. No differences were observed in terms of the operation time, perioperative outcomes, and short-term (< 90 days) postoperative complications between the two groups. There were no occurrences of UAS in the modified group, while there were two cases (3.70%) in the patients who received Bricker's ureteroileal anastomosis (p = 0.535).
In the present study, a simple and feasible modified technique of ileal conduit is proposed. Compared with traditional techniques, our method has several advantages, including the ability to avoid compression of the left ureter from the mesentery without establishing a retrosigmoid tunnel, a low rate of UAS, and the ability to perform a secondary operation at long-term follow-up.
在回肠导管转流手术中，左输尿管需要穿过乙状结肠下的情况尚未在任何研究中进行过调查。由于该手术可能会造成损伤，并且缺乏科学验证的优势，因此，在回肠导管中简单地使用改良技术，让左输尿管直接跨过乙状结肠。本研究旨在探讨所建议的手术技术的可行性，并评估围手术期结果和术后并发症，重点关注小肠梗阻（SBO）和输尿管-回肠吻合口狭窄（UAS）的发生率。
2018 年 1 月至 2020 年 4 月，对 84 例连续接受腹腔镜根治性膀胱切除术（LRC）和回肠导管尿流改道的患者进行了前瞻性单中心队列研究。对比 30 例接受改良手术的试验组和 54 例接受传统 Bricker 回肠导管的对照组之间 SBO 和 UAS 的发生率、围手术期结果和术后并发症。
两组患者的一般特征和临床病理特征具有可比性。两组患者的手术时间、围手术期结果和短期（<90 天）术后并发症均无差异。改良组未发生 UAS，而接受 Bricker 输尿管-回肠吻合术的患者中有 2 例（3.70%）发生 UAS（p=0.535）。
本研究提出了一种简单可行的回肠导管改良技术。与传统技术相比，我们的方法具有几个优点，包括能够避免左输尿管系膜受压，无需建立乙状结肠后隧道、UAS 发生率低以及能够在长期随访时进行二次手术。
