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开放性根治性膀胱切除术后回肠膀胱术与皮肤输尿管造口术的比较:中期随访90天发病率及导管依赖情况对比

Ileal Conduit versus Cutaneous Ureterostomy after Open Radical Cystectomy: Comparison of 90-Day Morbidity and Tube Dependence at Intermediate Term Follow-Up.

作者信息

Thakker Parth U, Refugia Justin Manuel, Wolff Dylan, Casals Randy, Able Corey, Temple Davis, Rodríguez Alejandro R, Tsivian Matvey

机构信息

Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA.

John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA.

出版信息

J Clin Med. 2024 Feb 5;13(3):911. doi: 10.3390/jcm13030911.

Abstract

: This study aims to compare perioperative morbidity and drainage tube dependence following open radical cystectomy (ORC) with ileal conduit (IC) or cutaneous ureterostomy (CU) for bladder cancer. : A single-center, retrospective cohort study of patients undergoing ORC with IC or CU urinary diversion between 2020 and 2023 was carried out. The 90-day perioperative morbidity, as per Clavien-Dindo (C.D.) complication rates (Minor C.D. I-II, Major C.D. III-V), and urinary drainage tube dependence (ureteral stent or nephrostomy tube) after tube-free trial were assessed. : The study included 56 patients (IC: 26, CU: 30) with a 14-month median follow-up. At 90 days after IC or CU, the frequencies of any, minor, and major C.D. complications were similar (any-69% vs. 77%; minor-61% vs. 73%; major-46% vs. 30%, respectively, > 0.2). Tube-free trial was performed in 86% of patients with similar rates of tube replacement (19% IC vs. 32% CU, = 0.34) and tube-free survival at 12 months was assessed (76% IC vs. 70% CU, = 0.31). : Compared to the ORC+IC, ORC+CU has similar rates of both 90-day perioperative complications and 12-month tube-free dependence. CU should be offered to select patients as an alternative to IC urinary diversion after RC.

摘要

本研究旨在比较开放性根治性膀胱切除术(ORC)联合回肠膀胱术(IC)或皮肤输尿管造口术(CU)治疗膀胱癌后的围手术期发病率和对引流管的依赖情况。

对2020年至2023年间接受ORC联合IC或CU尿流改道的患者进行了一项单中心回顾性队列研究。评估了90天围手术期发病率(根据Clavien-Dindo(C.D.)并发症发生率,轻微C.D. I-II级,严重C.D. III-V级)以及无管试验后的尿液引流管依赖情况(输尿管支架或肾造瘘管)。

该研究纳入了56例患者(IC组26例,CU组30例),中位随访时间为14个月。在IC或CU术后90天时,任何、轻微和严重C.D.并发症的发生率相似(任何并发症分别为69%对77%;轻微并发症分别为61%对73%;严重并发症分别为46%对30%,均>0.2)。86%的患者进行了无管试验,换管率相似(IC组19%对CU组32%,P = 0.34),并评估了12个月时的无管生存率(IC组76%对CU组70%,P = 0.31)。

与ORC+IC相比,ORC+CU的90天围手术期并发症发生率和12个月无管依赖率相似。对于部分患者,CU应作为RC术后IC尿流改道的替代方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/41b8/10856161/f0bcc53a6697/jcm-13-00911-g001.jpg

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