Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain; CEU Cardenal Herrera, Valencia, Spain.
Obstetrics and Gynecology Department, University Hospital Infanta Elena, Madrid, Spain.
Eur J Obstet Gynecol Reprod Biol. 2023 Mar;282:140-145. doi: 10.1016/j.ejogrb.2023.01.022. Epub 2023 Jan 23.
After exhausting other therapeutic options, pelvic exenteration is performed in patients who suffer from relapsed gynaecologic tumours, with most of them requiring some sort of urinary diversion.
The main objective of this study was to assess the short- and medium/long-term urinary complications associated with the Bricker ileal conduit versus double-barrelled wet colostomy after performing a pelvic exenteration for gynaecologic malignancies.
A total of 61 pelvic exenterations were identified between November 2010 and April 2022; 29 Bricker ileal conduits and 20 double-barrelled wet colostomies were included in the urinary diversion analysis. Regarding the specific short-term urinary complications, no differences were found in the rate of urinary leakage (3 vs 0 %; p = 1), urostomy complications (7 vs 0 %; p = 0.51), acute renal failure (10 vs 20 %; p = 0.24) or urinary infection (0 vs 5 %; p = 0.41). Up to 69 % of patients with Bricker ileal conduits and 65 % of double-barrelled wet colostomies (p = 0.76) presented specific medium/long-term urinary complications. No differences in the rates of pyelonephritis (59 vs 53 %; p = 0.71), urinary fistula (0 vs 12 %; p = 0.13), ureteral stricture (10 vs 6 %; p = 1), conduit failure and reconstruction (7 vs 0 %; p = 0.53), renal failure (38 vs 29 %; p = 0.56) or electrolyte disorders (24 vs 18 %; p = 0.72) were found.
There are no significant differences in the rate of complications between double-barrelled wet colostomy and the Bricker ileal conduit. The long-term complications related to urinary diversion remained high regardless of the type of technique. In this context, the double-barrelled wet colostomy presents advantages such as the single stoma placement and the simplicity of the technique.
在穷尽其他治疗选择后，患有复发妇科肿瘤的患者会进行盆腔廓清术，其中大多数需要进行某种类型的尿流改道。
本研究的主要目的是评估在妇科恶性肿瘤行盆腔廓清术后，行 Bricker 回肠膀胱造口术与双筒湿造口术相比，短期和中/长期尿路并发症。
2010 年 11 月至 2022 年 4 月共行 61 例盆腔廓清术，其中 29 例行 Bricker 回肠膀胱造口术，20 例行双筒湿造口术。关于具体的短期尿路并发症，尿漏发生率无差异（3 例比 0 例，p=1），尿造口并发症（7 例比 0 例，p=0.51），急性肾衰竭（10 例比 20 例，p=0.24）或尿路感染（0 例比 5 例，p=0.41）。Bricker 回肠膀胱造口术和双筒湿造口术分别有 69%和 65%的患者出现特定的中/长期尿路并发症（p=0.76）。肾盂肾炎发生率无差异（59 例比 53 例，p=0.71），尿瘘（0 例比 12 例，p=0.13），输尿管狭窄（10 例比 6 例，p=1），造口管失败和重建（7 例比 0 例，p=0.53），肾衰竭（38 例比 29 例，p=0.56）或电解质紊乱（24 例比 18 例，p=0.72）。
双筒湿造口术和 Bricker 回肠膀胱造口术的并发症发生率无显著差异。无论采用哪种技术，尿流改道的长期并发症发生率仍然很高。在这种情况下，双筒湿造口术具有单造口放置和技术简单的优点。
