Nguyen Thuy-My, Traeger Luke, Vather Ryash, Overall Bronwyn, Cho Jonathan, Sammour Tarik
Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
ANZ J Surg. 2023 Oct;93(10):2450-2456. doi: 10.1111/ans.18498. Epub 2023 May 2.
The ideal method for urinary diversion following total pelvic exenteration (TPE) remains unclear. This study compares the outcomes of double-barrelled uro-colostomy (DBUC) and ileal conduit (IC) in a single Australian centre.
All consecutive patients who underwent pelvic exenteration with the formation of either a DBUC or an IC between 2008 and November 2022 were identified from the prospective database from the Royal Adelaide Hospital and St. Andrews Hospital. Demographic, operative characteristics, general perioperative, long-term urological and other relevant surgical complications were compared via univariate analyses.
Of 135 patients undergoing exenteration, 39 patients were eligible for inclusion: 16 patients with a DBUC, and 23 patients with an IC. More patients in the DBUC group had previous radiotherapy (93.8% vs. 65.2%, P = 0.056) and flap pelvic reconstruction (93.7% vs. 45.5%, P = 0.002). The rate of ureteric stricture trended higher in the DBUC group (25.0% vs. 8.7%, P = 0.21), but in contrast, urine leak (6.3% vs. 8.7%, P>0.999), urosepsis (43.8% vs. 60.9%, P = 0.29), anastomotic leak (0.0% vs. 4.3%, P>0.999), and stomal complications requiring repair (6.3% vs. 13.0%, P = 0.63) trended lower. These differences were not statistically significant. Rates of grade III or greater complications were similar; however, no patients in the DBUC group died within 30-days or had grade IV complications requiring ICU admission compared with two deaths and one grade IV complication in the IC group.
DBUC is a safe alternative to IC for urinary diversion following TPE, with potentially fewer complications. Quality of life and patient-reported outcomes are required.
全盆腔脏器切除术（TPE）后理想的尿流改道方法仍不明确。本研究比较了澳大利亚一家中心双管输尿管结肠造口术（DBUC）和回肠膀胱术（IC）的治疗效果。
从皇家阿德莱德医院和圣安德鲁斯医院的前瞻性数据库中，识别出2008年至2022年11月期间所有接受盆腔脏器切除术并同时行DBUC或IC造口的连续患者。通过单因素分析比较人口统计学、手术特征、围手术期一般情况、长期泌尿系统及其他相关手术并发症。
135例行盆腔脏器切除术的患者中，39例符合纳入标准：16例行DBUC，23例行IC。DBUC组更多患者曾接受过放疗（93.8%对65.2%，P = 0.056）和皮瓣盆腔重建（93.7%对45.5%，P = 0.002）。DBUC组输尿管狭窄发生率呈上升趋势（25.0%对8.7%，P = 0.21），但相比之下，尿漏（6.3%对8.7%，P>0.999）、尿脓毒症（43.8%对60.9%，P = 0.29）、吻合口漏（0.0%对4.3%，P>0.999）以及需要修复的造口并发症（6.3%对13.0%，P = 0.63）呈下降趋势。这些差异无统计学意义。III级或更高级别并发症发生率相似；然而，DBUC组无患者在30天内死亡或出现需要入住重症监护病房的IV级并发症，而IC组有2例死亡和1例IV级并发症。
对于TPE后的尿流改道，DBUC是IC的一种安全替代方法，潜在并发症可能更少。还需要评估生活质量和患者报告的结果。
