The Journal of Practical Medicine ›› 2025, Vol. 41 ›› Issue (10): 1517-1524.doi: 10.3969/j.issn.1006-5725.2025.10.013
• Clinical Research • Previous Articles
Xufeng YU1,Meimian HUA2,Shuxiong ZENG1,Wei HE1,Ziwei WANG1,Qing CHEN1,Chen ZHANG1,Yue WANG1,Yi WANG1,Chuanliang. XU2()
Received:
2025-02-08
Online:
2025-05-25
Published:
2025-05-21
Contact:
Chuanliang. XU
E-mail:chuanliang_xu@126.com
CLC Number:
Xufeng YU,Meimian HUA,Shuxiong ZENG,Wei HE,Ziwei WANG,Qing CHEN,Chen ZHANG,Yue WANG,Yi WANG,Chuanliang. XU. Clinical efficacy comparison of ileal conduit, flap embedding method, and traditional cutaneous ureterostomy in patients with bladder cancer[J]. The Journal of Practical Medicine, 2025, 41(10): 1517-1524.
Tab.1
Comparison of general conditions of three groups"
项目 | A组(n = 21) | B组(n = 21) | C组(n = 21) | F/H/χ2 值 | P值 |
---|---|---|---|---|---|
年龄/岁 | 63.00 ± 6.20 | 65.10 ± 5.68 | 64.90 ± 5.79 | 0.812 | 0.449 |
性别/[例(%)] | 3.723 | 0.155 | |||
男 | 19(90.5) | 20(95.2) | 16(76.2) | ||
女 | 2(9.5) | 1(4.8) | 5(23.8) | ||
BMI/(kg/m2) | 23.15 ± 2.17 | 25.15 ± 3.28 | 22.92 ± 3.87 | 3.106 | 0.052 |
血肌酐/(μmol/L) | 81.62 ± 14.95 | 84.57 ± 23.00 | 77.71 ± 28.51 | 0.476 | 0.623 |
血胱抑素C[M(Q1,Q3)]/(mg/L) | 0.94(0.79,1.03) | 0.97 ± 0.31 | 0.86 ± 0.32 | 2.670 | 0.263 |
血尿素氮[M(Q1,Q3)]/(mmol/L) | 5.90(4.80,8.20) | 6.40(5.25,7.40) | 5.24 ± 1.51 | 5.734 | 0.057 |
血尿酸/(μmol/L) | 362.48 ± 79.58 | 331.00 ± 96.22 | 306.71 ± 91.53 | 2.055 | 0.137 |
ASA评分/[例(%)] | 7.000 | 0.136 | |||
Ⅰ | 0(0.0) | 2(9.5) | 1(4.8) | ||
Ⅱ | 21(100.0) | 15(71.4) | 18(85.7) | ||
Ⅲ | 0(0.0) | 4(19.0) | 2(9.5) | ||
术前肾积水/[例(%)] | 2.251 | 0.690 | |||
无 | 14(66.7) | 16(76.2) | 15(71.4) | ||
单侧 | 6(28.6) | 5(23.8) | 6(28.6) | ||
双侧 | 1(4.8) | 0(0.0) | 0(0.0) | ||
糖尿病/[例(%)] | 1.853 | 0.396 | |||
无 | 16(76.2) | 16(76.2) | 19(90.5) | ||
有 | 5(23.8) | 5(23.8) | 2(9.5) | ||
随访时间/d | 576.24 ± 79.96 | 609.48 ± 62.48 | 626.95 ± 73.27 | 2.660 | 0.078 |
Tab.3
Comparison of surgical data of three groups of patients"
项目 | A组(n = 21) | B组(n = 21) | C组(n = 21) | F/H/χ2 值 | P值 |
---|---|---|---|---|---|
手术时间/min | 315.00(285.00,360.00) | 276.57 ± 86.99 | 245.10 ± 47.20 | 15.669 | < 0.001 |
术中出血量/mL | 150.00(100.00,200.00) | 100.00(50.00,200.00) | 100.00(62.50,200.00) | 2.433 | 0.296 |
手术方式/[例(%)] | 0.129 | 0.938 | |||
机器人辅助腹腔镜 | 9(42.9) | 9(42.9) | 10(47.6) | ||
传统腹腔镜 | 12(57.1) | 12(57.1) | 11(52.4) | ||
组织学类型/[例(%)] | 2.940 | 0.938 | |||
尿路上皮癌 | 17(81.0) | 17(81.0) | 16(76.2) | ||
尿路上皮癌伴鳞状分化 | 0(0.0) | 1(4.8) | 1(4.8) | ||
尿路上皮癌伴肉瘤样变 | 1(4.8) | 0(0.0) | 1(4.8) | ||
乳头状尿路上皮癌 | 1(4.8) | 2(9.5) | 2(9.5) | ||
小细胞癌 | 2(9.5) | 1(4.8) | 1(4.8) | ||
T分期/[例(%)] | 17.623 | < 0.05 | |||
T1 | 7(33.3) | 12(57.1) | 7(33.3) | ||
T2 | 9(42.9) | 1(4.8) | 2(9.5) | ||
T3 | 3(14.3) | 3(14.3) | 9(42.9) | ||
T4 | 2(9.5) | 5(23.8) | 3(14.3) | ||
淋巴结转移/[例(%)] | 0.778 | 0.678 | |||
有 | 2(9.5) | 3(14.3) | 4(19.0) | ||
无 | 19(90.5) | 18(85.7) | 17(81.0) | ||
住院时间(x ± s)/d | 8.81 ± 2.27 | 7.00(6.50,9.00)? | 7.81 ± 2.56 | 0.997 | 0.375 |
Tab.4
Comparison of preoperative and postoperative renal function indexes in group A"
项目 | A组(n = 21) | |||
---|---|---|---|---|
术前 | 术后 | t/χ2 值 | P值 | |
血肌酐(x ± s)/(μmol/L) | 81.62 ± 14.95 | 86.24 ± 23.12 | -1.008 | 0.326 |
血胱抑素C/(mg/L) | 0.94(0.79,1.03) | 0.97(0.87,1.25) | 140.500 | 0.385 |
血尿素氮/(mmol/L) | 5.90(4.80,8.20) | 5.50 ± 2.19 | 159.000 | 0.130 |
血尿酸(x ± s)/(μmol/L) | 362.48 ± 79.58 | 270.00(221.00,343.00) | 209.000 | < 0.05 |
肾积水情况对比/[例(%)] | 9.606 | < 0.05 | ||
无 | 14(66.7) | 15(71.4) | ||
单侧 | 6(28.6) | 0(0.0) | ||
双侧 | 1(4.8) | 6(28.6) |
Tab.5
Comparison of preoperative and postoperative renal function indexes in group B"
项目 | B组(n=21) | |||
---|---|---|---|---|
术前 | 术后 | t/χ2 值 | P值 | |
血肌酐(x ± s)/(μmol/L) | 84.57 ± 23.00 | 93.70 ± 20.70 | -2.013 | 0.058 |
血胱抑素C(x ± s)/(mg/L) | 0.97 ± 0.31 | 1.05 ± 0.29 | 1.518 | 0.145 |
血尿素氮/(mmol/L) | 6.40(5.25,7.40) | 5.81 ± 1.51 | 85.000 | 0.289 |
血尿酸(x ± s)/(μmol/L) | 331.00 ± 96.22 | 324.16 ± 94.56 | 0.476 | 0.639 |
肾积水情况对比/[例(%)] | 2.403 | 0.301 | ||
无 | 16(76.2) | 18(85.7) | ||
单侧 | 5(23.8) | 2(9.5) | ||
双侧 | 0(0.0) | 1(4.8) |
Tab.6
Comparison of preoperative and postoperative renal function indexes in group C"
项目 | C组(n = 21) | |||
---|---|---|---|---|
术前 | 术后 | t/χ2 值 | P值 | |
血肌酐/(μmol/L) | 77.71 ± 28.51 | 95.38 ± 37.08 | -3.131 | < 0.05 |
血胱抑素C/(mg/L) | 0.86 ± 0.32 | 1.03 ± 0.31 | 1.658 | 0.114 |
血尿素氮/(mmol/L) | 5.24 ± 1.51 | 5.19 ± 1.77 | 0.154 | 0.879 |
血尿酸/(μmol/L) | 306.71 ± 91.53 | 283.57 ± 94.15 | 1.719 | 0.101 |
肾积水情况对比/[例(%)] | 3.333 | 0.189 | ||
无 | 15(71.4) | 12(57.1) | ||
单侧 | 6(28.6) | 6(28.6) | ||
双侧 | 0(0.0) | 3(14.3) |
Tab.7
Comparison of the incidence of related complications in the three groups within six months after operation"
并发症 | CD分级 | 干预措施 | A组(n = 21) | B组(n = 21) | C组(n = 21) | χ2 值 | P值 |
---|---|---|---|---|---|---|---|
肠梗阻 | Ⅰ | 补液 | 0(0.0) | 0(0.0) | 1(4.8) | 1.939 | 0.379 |
Ⅲ | 胃肠减压 | 5(23.8) | 0(0.0) | 1(4.8) | 7.737 | <0.05 | |
Ⅳ | 手术治疗 | 1(4.8) | 1(4.8) | 0(0.0) | 1.010 | 0.604 | |
无症状细菌尿 | Ⅰ | 保守治疗,未用抗生素 | 2(9.5) | 2(9.5) | 1(4.8) | 0.497 | 0.780 |
尿路感染 | Ⅱ | 抗生素治疗 | 4(19.0) | 5(23.8) | 7(33.3) | 0.958 | 0.619 |
肾积水 | Ⅰ | 保守治疗,临床观察 | 4(19.0) | 2(9.5) | 3(14.3) | 0.793 | 0.673 |
Ⅱ | 重新放置单J管 | 1(4.8) | 1(4.8) | 6(28.6) | 7.159 | <0.05 | |
尿路结石 | Ⅰ | 保守治疗,临床观察 | 2(9.5) | 2(9.5) | 1(4.8) | 0.497 | 0.780 |
切口感染 | Ⅲ | 切开引流 | 0(0.0) | 1(4.8) | 1(4.8) | 1.010 | 0.604 |
感染性休克 | Ⅳ | 补液、抗感染治疗 | 0(0.0) | 1(4.8) | 1(4.8) | 1.010 | 0.604 |
肺动脉栓塞 | Ⅲ | 溶栓治疗 | 1(4.8) | 0(0.0) | 0(0.0) | 1.939 | 0.379 |
失眠 | Ⅰ | 保守治疗,临床观察 | 0(0.0) | 1(4.8) | 1(4.8) | 1.010 | 0.604 |
Tab.8
Comparison of quality of life scores among the three groups of patients"
变量 | A组(n = 21) | B组(n = 21) | C组(n = 21) | H值 | P值 |
---|---|---|---|---|---|
MO | 0.066(0.000,0.112) | 0.066(0.033,0.066) | 0.158(0.066,0.158) | 9.980 | < 0.05 |
SC | 0.048(0.000,0.048) | 0.048(0.024,0.082) | 0.116(0.048,0.116) | 4.819 | 0.09 |
UA | 0.045(0.000,0.107) | 0.045(0.045,0.107) | 0.107(0.045,0.107) | 2.457 | 0.29 |
PD | 0.058(0.000,0.138) | 0.058(0.058,0.138) | 0.138(0.058,0.252) | 6.007 | 0.05 |
AD | 0.000(0.000,0.118) | 0.049(0.000,0.049) | 0.118(0.049,0.167) | 10.012 | < 0.05 |
健康效用值 | 0.792(0.338,0.942) | 0.731(0.558,0.812) | 0.363(0.154,0.782) | 7.591 | < 0.05 |
1 | 张娅威,施鸿金,付什,等. TIGIT的生物学作用及其在膀胱癌中应用的研究进展[J]. 实用医学杂志, 2024, 40(12): 1762-1766. |
2 |
SIEGEL R L, KRATZER T B, GIAQUINTO A N, et al. Cancer statistics, 2025[J]. CA Cancer J Clin, 2025, 75(1): 10-45. doi:10.3322/caac.21871
doi: 10.3322/caac.21871 |
3 |
LOPEZ-BELTRAN A, COOKSON M S, GUERCIO B J, et al. Advances in diagnosis and treatment of bladder cancer[J]. BMJ, 2024, 384: e076743. doi:10.1136/bmj-2023-076743
doi: 10.1136/bmj-2023-076743 |
4 | 肖峰, 姜锡男, 舒露,等. ECM1基因在膀胱癌中的表达及其与临床病理特征及预后关系[J].实用医学杂志,2023, 39(20): 2629-2632. |
5 |
LENIS A T, LEC P M, CHAMIE K. Urinary Diversion[J]. JAMA, 2020, 324(21): 2222. doi:10.1001/jama.2020.17604
doi: 10.1001/jama.2020.17604 |
6 |
SASAKI Y, YAMAMOTO Y, FUKUTA K, et al. Cutaneous ureterostomy following robot-assisted radical cystectomy: A multicenter comparative study of transperitoneal versus retroperitoneal techniques[J]. World J Urol, 2024, 42(1): 591. doi:10.1007/s00345-024-05300-x
doi: 10.1007/s00345-024-05300-x |
7 |
FLORES-MIRELES A L, WALKER J N, CAPARON M, et al. Urinary tract infections: Epidemiology, mechanisms of infection and treatment options[J]. Nat Rev Microbiol, 2015, 13(5): 269-284. doi:10.1038/nrmicro3432
doi: 10.1038/nrmicro3432 |
8 |
LIU Z, TIAN Q, XIA S, et al. Evaluation of the improved tubeless cutaneous ureterostomy technique following radical cystectomy in cases of invasive bladder cancer complicated by peritoneal metastasis[J]. Oncol Lett, 2016, 11(2): 1401-1405. doi:10.3892/ol.2015.4045
doi: 10.3892/ol.2015.4045 |
9 | 于徐锋, 花梅免, 曾蜀雄, 等. 输尿管皮肤造口术-皮瓣嵌入法用于根治性膀胱切除术+尿流改道术10例效果初探[J]. 现代泌尿外科杂志, 2024, 29(12): 1099-1103. |
10 |
TSAI A P Y, HUR S A, WONG A, et al. Minimum important difference of the EQ-5D-5L and EQ-VAS in fibrotic interstitial lung disease[J]. Thorax, 2021, 76(1): 37-43. doi:10.1136/thoraxjnl-2020-214944
doi: 10.1136/thoraxjnl-2020-214944 |
11 |
MORTENSEN C B, ANDERSEN-RANBERG N C, POULSEN L M, et al. Long-term outcomes with haloperidol versus placebo in acutely admitted adult ICU patients with delirium[J]. Intensive Care Med, 2024, 50(1): 103-113. doi:10.1007/s00134-023-07282-7
doi: 10.1007/s00134-023-07282-7 |
12 | 杜市,邬丹,陈静. 我国老年人健康素养与健康相关生命质量的相关性分析[J].现代预防医学,2025,52(4):709⁃715. |
13 |
VAN HOUT B A, SHAW J W. Mapping EQ-5D-3L to EQ-5D-5L[J]. Value Health, 2021, 24(9): 1285-1293. doi:10.1016/j.jval.2021.03.009
doi: 10.1016/j.jval.2021.03.009 |
14 |
METZEMAEKERS J, BOUWMAN L, DE VOS M, et al. Clavien-Dindo, comprehensive complication index and classification of intraoperative adverse events: A uniform and holistic approach in adverse event registration for (deep) endometriosis surgery[J]. Hum Reprod Open, 2023, 2023(2): hoad019. doi:10.1093/hropen/hoad019
doi: 10.1093/hropen/hoad019 |
15 | 中华医学遗传学杂志. 关于统计学检验结论在文章中表达的要求[J].中华医学遗传学杂志,2016, 33(4): 457. |
16 |
CORFIELD J M, ABOUASSALY R, LAWRENTSCHUK N. Health information quality on the internet for bladder cancer and urinary diversion: A multi-lingual analysis[J]. Minerva Urol Nefrol, 2018, 70(2): 137-143. doi:10.23736/s0393-2249.17.02952-6
doi: 10.23736/s0393-2249.17.02952-6 |
17 |
SONPAVDE G P, MOUW K W, MOSSANEN M. Therapy for Muscle-Invasive Urothelial Carcinoma: Controversies and Dilemmas[J]. J Clin Oncol, 2022, 40(12): 1275-1280. doi:10.1200/jco.21.02928
doi: 10.1200/jco.21.02928 |
18 |
KORKES F, PALOU J. High mortality rates after radical cystectomy: We must have acceptable protocols and consider the rationale of cutaneous ureterostomy for high-risk patients[J]. Int Braz J Urol, 2019, 45(6): 1090-1093. doi:10.1590/s1677-5538.ibju.2019.06.03
doi: 10.1590/s1677-5538.ibju.2019.06.03 |
19 |
BURKHARD F C, WUETHRICH P Y. Cutaneous ureterostomy: 'Back to the future'[J]. BJU Int, 2016, 118(4): 493-494. doi:10.1111/bju.13532
doi: 10.1111/bju.13532 |
20 |
KORKES F, FERNANDES E, GUSHIKEN F A, et al. Bricker ileal conduit vs. Cutaneous ureterostomy after radical cystectomy for bladder cancer: A systematic review[J]. Int Braz J Urol, 2022, 48(1): 18-30. doi:10.1590/s1677-5538.ibju.2020.0892
doi: 10.1590/s1677-5538.ibju.2020.0892 |
21 |
LIU Y, ZHANG J, CHEN H, et al. Urinary microbiota signatures associated with different types of urinary diversion: A comparative study[J]. Front Cell Infect Microbiol, 2023, 13: 1302870. doi:10.3389/fcimb.2023.1302870
doi: 10.3389/fcimb.2023.1302870 |
22 |
MOEEN A M, FARAGALLAH M A, ZARZOUR M A, et al. Ileal conduit versus single stoma uretero-cutanoustomy after radical cystectomy in patients ≥ 75 years; which technique is better? A prospective randomized comparative study[J]. Int Urol Nephrol, 2023, 55(7): 1719-1726. doi:10.1007/s11255-023-03609-x
doi: 10.1007/s11255-023-03609-x |
23 |
KADORIKU F, SASAKI Y, FUKUTA K, et al. A propensity score matching study on robot-assisted radical cystectomy for older patients: Comparison of intracorporeal ileal conduit and cutaneous ureterostomy[J]. BMC Urol, 2022, 22(1): 174. doi:10.1186/s12894-022-01123-3
doi: 10.1186/s12894-022-01123-3 |
24 |
LONGO N, IMBIMBO C, FUSCO F, et al. Complications and quality of life in elderly patients with several comorbidities undergoing cutaneous ureterostomy with single stoma or ileal conduit after radical cystectomy[J]. BJU Int, 2016, 118(4): 521-526. doi:10.1111/bju.13462
doi: 10.1111/bju.13462 |
25 |
TSATURYAN A, SAHAKYAN S, MURADYAN A, et al. A new modification of tubeless cutaneous ureterostomy following radical cystectomy[J]. Int Urol Nephrol, 2019, 51(6): 959-967. doi:10.1007/s11255-019-02145-x
doi: 10.1007/s11255-019-02145-x |
26 |
AY A A, KUTUN S, ULUCANLAR H, et al. Risk factors for postoperative ileus[J]. J Korean Surg Soc, 2011, 81(4): 242-249. doi:10.4174/jkss.2011.81.4.242
doi: 10.4174/jkss.2011.81.4.242 |
Viewed | ||||||
Full text |
|
|||||
Abstract |
|
|||||