改良输尿管回肠膀胱吻合及其对术后早期并发症的影响

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目的:比较回肠膀胱术中三种输尿管回肠吻合方式,探讨改良输尿管回肠吻合术的临床应用价值。方法:回顾性分析117例行全膀胱切除+回肠膀胱术膀胱癌患者的临床资料,根据术中输尿管回肠吻合方式的不同分为三组:A组输尿管-回肠端侧吻合,44例88侧;B组输尿管-回肠端侧插入,37例74侧;C组输尿管回肠端端插入(改良组),36例72侧。收集三组患者的临床资料,根据Clavien-Dindo分级系统对术后并发症进行分级,分析三种吻合方式术后90天内并发症发生情况。结果:三组患者手术均顺利完成。三组患者比较术后90天内并发症发生率,差异有统计学意义(P<0.01),C组的并发症发生率最低。轻度并发症(Ⅰ~Ⅱ级),C组较A组和B组发生率差异无统计学意义(P>0.05);重度并发症(Ⅲ~Ⅴ级)和输尿管漏尿和狭窄的发生率,C组均较A组和B组显著降低,差异有统计学意义(P<0.01)。结论:改良输尿管回肠膀胱吻合可有效降低术后并发症发生率,减少吻合口狭窄、漏尿,提高患者术后生活质量,是一种简单有效的输尿管肠管吻合方法。 Objective: To compare the three ureteral ileal anastomosis modes in ileal bladder surgery and to explore the clinical value of modified ureteral ileal anastomosis. Methods: The clinical data of 117 patients undergoing total cystectomy and ileal bladder surgery were retrospectively analyzed. According to the intraoperative ureteral ileal anastomosis, the patients were divided into three groups: group A ureteral - ileal anastomosis, 44 cases 88 sides; In group B, the distal uretero-ileum was inserted and 37 cases were in 74 sides. The distal ureter in group C was inserted (modified group) and 36 cases in 72 sides. The clinical data of the three groups were collected. The postoperative complications were graded according to the Clavien-Dindo grading system. The complications of the three anastomoses were analyzed within 90 days after operation. Results: The three groups of patients were successfully completed. Comparing the incidence of complications in the three groups after 90 days, the difference was statistically significant (P <0.01). The incidence of complications in group C was the lowest. There was no significant difference in the incidence of mild complication (grade Ⅰ ~ Ⅱ) between group C and group A and group B (P> 0.05). The incidence of severe complications (grade Ⅲ ~ Ⅴ) and uretericoule stenosis , C group were significantly lower than the A and B group, the difference was statistically significant (P <0.01). Conclusion: Improved ureteral ileum anastomosis can effectively reduce the incidence of postoperative complications, reduce anastomotic stenosis, leakage of urine and improve postoperative quality of life. It is a simple and effective ureteral anastomosis.
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