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首页> 外文期刊>Acta Cirurgica Brasileira >Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy
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Cutaneous ureterostomy with definitive ureteral stent as urinary diversion option in unfit patients after radical cystectomy

机译：根治性膀胱切除术后不适合患者的皮肤输尿管造口术，使用确定的输尿管支架作为尿路转移选择

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PURPOSE: Simple diversions are underutilized, mostly for unfit, bedridden, and very self-limited patients requiring palliative surgical management due to life-threatening conditions. Experience with cutaneous ureterostomy (CU) as palliative urinary diversion option for unfit bladder cancer patients is reported. METHODS: We retrospectively reviewed clinical and operative parameters of 41 patients who underwent CU following RC in three specialized Cancer Centers from July/2005 to July/2010. Muscle-invasive disease (clinical Stage T2/worse), multifocal high-grade tumor, and carcinoma in situ refractory to intravesical immunotherapy were the main indications for RC. Double-J ureteral stents were used in all patients and replaced every 6 months indefinitly. Peri-operative morbidity and mortality were evaluated. RESULTS: Median age was 69 years (interquartile range - IQR 62, 76); 30 (73%) patients were men. Surgery in urgency setting was performed in 25 (61%) of patients, most due to severe bleeding associated with hemodynamic instability; 14 patients (34%) showed an American Society of Anesthesiologists score 4. Median operative time was 180 minutes (IQR 120, 180). Peri-operative complications occurred in 30 (73%) patients, most Clavien grade I and II (66.6 %). There was no per-operative death. Re-intervention was necessary in 7 (17%) patients. Overall survival was 24% after 9.4 months follow-up. CONCLUSIONS: CU with definitive ureteral stenting represents a simplified alternative for urinary diversion after palliative cystectomy in unfit patients. It can be performed quickly, with few early and late postoperative complications allowing RC in a group of patients otherwise limited to suboptimal alternatives. Future studies regarding the quality of life are warranted.
机译：目的：简单的转移利用未得到充分利用，主要用于因生命危险而需要姑息性手术治疗的身体不适，卧床不起，自我限制的患者。据报道，对于不适合的膀胱癌患者，使用输尿管造口术（CU）作为姑息性尿路转移治疗的经验。方法：我们回顾性分析了从2005年7月/ 2005年至2010年7月在三个专门的癌症中心进行CU后进行CU的41例患者的临床和手术参数。肌肉浸润性疾病（临床T2 / worse期），多灶性高级别肿瘤以及膀胱内免疫治疗难治性原位癌是RC的主要适应症。所有患者均使用双J输尿管支架，并每6个月不确定更换一次。评估围手术期的发病率和死亡率。结果：中位年龄为69岁（四分位间距-IQR 62，76）; 30名（73％）患者为男性。有25名患者（61％）进行了急诊手术，这主要是由于严重出血引起的血流动力学不稳定。 14例患者（34％）表现出美国麻醉医师学会评分4。中位手术时间为180分钟（IQR 120，180）。围手术期并发症发生在30例患者中（73％），大多数为Clavien I级和II级患者（66.6％）。没有手术死亡。 7名（17％）患者需要再次干预。在9.4个月的随访后，总生存率为24％。结论：在不适合的患者中，使用明确的输尿管支架置入术是姑息性膀胱切除术后尿流改道的简化替代方案。它可以快速进行，几乎没有术后早期和晚期并发症，因此可以限制一组患者的RC，否则只能选择次优方案。有必要对生活质量进行进一步的研究。

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