Can Osman, Danış Eyyüp, Kutlutürk Eren Görkem, Polat Emre Can, Ötünçtemur Alper
Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey.
Surg Oncol. 2024 Feb;52:102036. doi: 10.1016/j.suronc.2024.102036. Epub 2024 Jan 5.
A clear consensus has not yet been reached on the optimal ureteroenteric anastomosis technique for ileal conduit urinary diversion following radical cystectomy. This study aims to determine the incidence of strictures and their management associated with these anastomosis techniques.
We conducted a retrospective, single-center study of patients who underwent radical cystectomy and urinary diversion between March 2014 and August 2022. Patients were categorized based on the ureteroenteric anastomosis technique used: Wallace, Bricker, or Hybrid. Strictures were identified through antegrade pyelography following nephrostomy placement.
A total of 141 patients were included in the study, with 60 patients in the Wallace group (42 %), 42 patients in the Bricker group (30 %), and 39 patients in the Hybrid group (28 %). The overall incidence of ureteroenteric strictures was 15 %, with 7 patients in the Wallace group, 11 patients in the Bricker group, and 3 patients in the Hybrid group experiencing strictures. There was no statistically significant difference in stricture rates between the Wallace and Bricker groups (11 % vs. 26 %, p = 0.09) or between the Wallace and Hybrid groups (11 % vs. 7 %, p = 0.73). However, a statistically significant difference was observed between the Bricker and Hybrid groups (26 % vs. 7 %, p = 0.03). The mean time to stricture development was 9.2 ± 3.3 months for the Wallace group, 9.5 ± 3.7 months for the Bricker group, and 12.6 ± 5 months for the Hybrid group (p = 0.407).
The Hybrid ureteroenteric anastomosis technique exhibits a lower stricture rate compared to the Bricker and Wallace techniques. It represents a safe and feasible alternative technique.
对于根治性膀胱切除术后回肠代膀胱尿流改道的最佳输尿管肠吻合技术，目前尚未达成明确共识。本研究旨在确定与这些吻合技术相关的狭窄发生率及其处理方法。
我们对2014年3月至2022年8月期间接受根治性膀胱切除术和尿流改道的患者进行了一项回顾性单中心研究。根据所采用的输尿管肠吻合技术对患者进行分类：华莱士术式、布里克术式或混合术式。通过肾造瘘术后的顺行肾盂造影确定狭窄情况。
本研究共纳入141例患者，其中华莱士组60例（42%），布里克组42例（30%），混合组39例（28%）。输尿管肠狭窄的总体发生率为15%，华莱士组有7例患者、布里克组有11例患者、混合组有3例患者出现狭窄。华莱士组和布里克组之间的狭窄率无统计学显著差异（11%对26%，p = 0.09），华莱士组和混合组之间也无统计学显著差异（11%对7%，p = 0.73）。然而，布里克组和混合组之间观察到有统计学显著差异（26%对7%，p = 0.03）。华莱士组狭窄发生的平均时间为9.2±3.3个月，布里克组为9.5±3.7个月，混合组为12.6±5个月（p = 0.407）。
与布里克术式和华莱士术式相比，混合输尿管肠吻合技术的狭窄率较低。它是一种安全可行的替代技术。
