改良回肠膀胱腹壁造瘘术的疗效分析

Effect analysis of modified ileum bladder abdominal wall fistula

摘要:

目的： 对回肠膀胱腹壁造瘘术进行改良，评价其临床疗效。方法： 回顾性分析重庆市璧山区人民医院泌尿外科2010年1月至2020年1月行改良回肠膀胱腹壁造瘘术（研究组）及Bricker术（对照组）患者的一般资料、围手术期情况、术后并发症等资料。结果： 研究组35例，对照组48例，2组患者的一般临床资料无统计学差异（P>0.05），研究组平均手术时间为（76.3±5.5）min，明显短于对照组的（111.0±5.4）min（P<0.05），但2组在术中出血、术后住院时间、术后拔除盆腔引流管时间、术后拔除输尿管支架时间、术后TNM分期等方面无统计学差异（P>0.05）。研究组术后总肾功异常发生率、造瘘口周围皮炎及疤痕发生率明显低于对照组（P<0.05），但术后漏尿、代膀胱结石、回肠造瘘口坏死或狭窄等方面均无统计学差异（P>0.05）。研究组术后粘连性肠梗阻和肾积水的发生率均为0，明显低于传统回肠膀胱腹壁造瘘组的12.7%和15.9%（P<0.05）。结论： 改良回肠膀胱腹壁造瘘术临床疗效可靠，手术时间更短，可避免Bricker术及传统回肠膀胱腹壁造瘘术的并发症，有望成为更加理想的尿流改道术式。

Abstract:

Objective: To improve the ileum bladder abdominal wall fistula and evaluate its clinical effect. Methods: From January 2010 to January 2020, the general data, perioperative condition and postoperative complications of the patients who underwent the modified ileum bladder abdominal wall fistula (the study group) and Bricker operations (the control group) were analyzed retrospectively. Results: There were 35 cases in the study group and 48 cases in the control group. There was no significant difference in the general clinical data between two groups (P>0.05). The average operation time in the study group was (76.3±5.5) min, which was significantly shorter than that in the control group of (111.0±5.4) min (P<0.05). However, there was no statistical difference in bleeding, hospitalization time, drainage time, ureteral stent removal time and postoperative TNM staging between two groups (P>0.05). The incidence of total renal function abnormality, dermatitis around the stoma and scar in the study group were significantly lower than that in the control group (P<0.05), but leakage of urine, replacement of bladder stones, necrosis or stenosis of ileostomy between two groups had significant differences (P>0.05). The incidence of adhesive ileus and hydronephrosis in the study group was 0%, which was significantly lower than that in the traditional ileostomy group (12.7%, 15.9%) (P<0.05). Conclusion: The improved ileum bladder abdominal wall fistula has more reliable clinical effect and shorter operation time, and can avoid the complications of Bricker’s operation and traditional ileum bladder abdominal wall fistula, which is expected to become a more ideal urinary diversion operation.