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目的比较Bricker与Wallace两种输尿管回肠肠襻吻合方式的临床疗效。方法回顾性分析2008年1月至2015年2月124例接受根治性膀胱切除联合尿流改道患者的临床资料。根据输尿管回肠肠襻吻合方式的不同,将患者分为两组:Bricker组74例,Wallace组50例,比较两组患者治疗效果。结果术前Wallace组患者肾积水(36.0%vs.10.8%,P=0.006)及肾功能不全(16.0%vs.2.7%,P=0.008)发生率显著高于Bricker组,而在平均年龄、身体质量指数(BMI)、性别构成、高血压及糖尿病史、腹部放疗史及膀胱手术史、肿瘤病理分级及临床分期等方面相比均无明显统计差异;术后Wallace组手术时间(4.2hvs.5.3h,P=0.043)、输尿管切缘阳性率(0vs.8.1%,P=0.039)及术后肾积水(0vs.10.8%,P=0.015)发生率均明显低于Bricker组,差异有显著统计学意义。结论 Wallace输尿管回肠肠襻联合吻合术式能有效降低术后肾积水发生率,有利于患者术后肾功能的恢复,减少输尿管切缘阳性率,值得推广应用。
Objective To compare the clinical efficacy of two types of ureteric ileum anastomosis between Bricker and Wallace. Methods The clinical data of 124 patients undergoing radical cystectomy combined with urinary diversion from January 2008 to February 2015 were retrospectively analyzed. Patients were divided into two groups according to the anastomosis of ureteral enteric 襻: 74 in the Bricker group and 50 in the Wallace group. The treatment effect was compared between the two groups. Results The incidence of hydronephrosis (36.0% vs.10.8%, P = 0.006) and renal insufficiency (16.0% vs.2.7%, P = 0.008) in the preoperative Wallace group was significantly higher than that in the Bricker group, while in the mean age, Body mass index (BMI), sex composition, history of hypertension and diabetes mellitus, history of abdominal radiotherapy and history of bladder surgery, tumor pathological grading and clinical stage compared with no statistically significant differences; postoperative Wallace group operation time (4.2hvs. 5.3h, P = 0.043), the positive rate of ureterotomy (0 vs.8.1%, P = 0.039) and postoperative hydronephrosis (0vs.10.8%, P = 0.015) were significantly lower than that of Bricker group Significant statistical significance. Conclusion The combination of Wallace ureter and intestinal enteromial joint anastomosis can effectively reduce the incidence of postoperative hydronephrosis, is conducive to the recovery of postoperative renal function and reduce the positive rate of ureter incision, which is worth popularizing and applying.