Treatment of benign uretero-ileal anastomotic stricture after radical cystectomy and urinary diversion
Objective:To investigate the efficacy and safety of robot-assisted laparoscopic uretero-ileal anastomotic stricture resec-tion+replantation versus percutaneous nephroscopic balloon dilatation+catheterization in the treatment of uretero-ileal anastomotic stricture after radical cystotomy and urine diversion through a retrospective control study,and to provide new ideas for the treatment of benign uretero-ileal anastomotic stricture.Methods:A retrospective analysis was performed for the clinical data of 63 patients who ex-perienced benign uretero-ileal anastomotic stricture after robot-assisted or conventional laparoscopic radical cystectomy and urinary diversion in Zhejiang Provincial People's Hospital from October 2014 to December 2023,and the patients underwent either Bricker procedure or in situ ileal neobladder urinary diversion.According to the treatment method for benign uretero-ileal anastomotic stric-ture,the patients were divided into group 1(27 patients receiving endoscopic balloon dilatation or combined endoscopic holmium laser incision)and group 2(36 patients receiving robot-assisted or conventional laparoscopic ureteral reimplantation).The two groups were compared in terms of basic data,perioperative conditions,surgical outcome,and safety.Results:There were no significant differences between the two groups in sex,age,body mass index,length of stric-ture,preoperative creatinine,preoperative urea,preoperative hemo-globin,preoperative glomerular filtration rate(GFR)of the affected side,and degree of hydronephrosis(P＞0.05).In terms of the intra-operative and postoperative data of the two groups,compared with laparoscopic reimplantation,endoscopic treatment had significantly shorter time of operation[(97±31)min vs.(185±36)min,t=-2.641,P=0.000],length of postoperative hospital stay[(5.9±1.9)d vs.(8.1±3.1)d,t=-3.144,P=0.000],and time to postoperative first eat-ing[(1.7±0.8)d vs.(2.9±1.3)d,t=-4.320,P=0.000].There was no significant difference in blood transfusion between the two groups during and after surgery(P＞0.05).As for the comparison of clinical outcome after surgery between the two groups,compared with the endoscopic treatment group,the laparoscopic reimplantation group had a significantly shorter mean time of D-J tube placement[(6.1±2.0)months vs.(4.0±3.5)months,t=2.824,P=0.010],a significantly lower recurrence rate of anastomotic stricture(P=0.020),and a significantly better increase in GFR of the affected kidney(P=0.000).Conclusion:For the treatment of benign uretero-ileal anasto-motic stricture after radical cystotomy and urine diversion and based on the length of the ureter with stricture,compared with endo-scopic treatment,laparoscopic reimplantation can better address the problem of benign uretero-ileal anastomotic stricture,with higher cure rate of stricture and improvement rate of renal function.
万方数据
维普
