Analysis of influencing factors in stoma stenosis after radical cystectomy plus ureterocutaneostomy
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摘要: 目的 分析膀胱全切并输尿管皮肤造口术后吻合口狭窄的影响因素，为临床预防输尿管皮肤造口术后吻合口狭窄提供参考依据。方法 回顾性分析2019年1月—2021年12月在海军军医大学第一附属医院行输尿管皮肤造口术80例患者的临床资料，对其造口狭窄的相关因素进行单因素分析和多因素logistic回归分析。结果 44例患者发生输尿管皮肤吻合口狭窄，发生率为55%。Logistic回归分析显示，术中植入导管型号、清洗造口频率、瘢痕体质为输尿管皮肤造口术后吻合口狭窄的主要影响因素(P＜0.05)。结论 输尿管皮肤造口患者吻合口狭窄发生率较高。选择内径较粗的F8输尿管支架管，按指南要求频率清洗造口1次/d，重点关注瘢痕体质患者术后愈合情况等为输尿管皮肤造口术后吻合口狭窄的针对性预防措施。Abstract: Objective To analyze the influencing factors in stoma stenosis after total cystectomy plus ureterocutaneostomy and to provide a reference basis for clinical prevention of postoperative stoma stenosis.Methods The clinical data of 80 patients who underwent ureterocutaneostomy from January 2019 to December 2021 in Changhai Hospital Affiliated to the PLA Navy Medical University were retrospectively analyzed, and the factors associated with their stoma stenosis were analyzed by single-factor analysis and multi-factor logistic regression.Results Stoma stricture occurred in 44 patients, with an incidence of 55%. Logistic regression analysis showed that the type of catheter implanted intraoperatively, frequency of cleaning the stoma, and whether the patients were scarred, were the main influencing factors in stoma stricture after ureterocutaneostomy (P < 0.05).Conclusion The incidence of stoma stricture was higher in patients with ureterocutaneostomy. Measures such as choosing a thicker inner diameter F8 ureteral stent tube, cleaning the stoma once a day as frequently as required by the guidelines, and focusing on postoperative healing in patients with scarring constitution will lay the foundation for targeted preventive measures for stoma stenosis after ureterocutaneostomy in the future.
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Key words:
- bladder cancer /
- ureterocutaneostomy /
- stoma stenosis /
- influencing factor
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表 1 输尿管皮肤造口患者的一般情况及造口狭窄情况
项目 例数 百分比/% 性别 男 67 83.75 女 13 16.25 年龄/岁 ＜60 19 23.75 60~70 37 46.25 ＞70 24 30.00 BMI/(kg/m2) ＜18.5 1 1.25 18.5~23.9 29 36.25 ＞23.9 50 62.50 合并基础疾病种类 高血压 35 43.75 糖尿病 20 25.00 消化系统 4 5.00 心血管系统 7 8.75 泌尿系统 5 6.25 免疫系统 1 1.25 吸烟饮酒史 有 51 63.75 无 29 36.25 术中有无输血 有 4 5.00 无 76 95.00 有无使用机器人辅助 有 54 67.50 无 26 32.50 术后血白细胞 4×109/L~10×109/L 52 65.00 < 4×109/L或>10×109/L 28 35.00 术后造口有无发生狭窄 有 44 55.00 无 36 45.00 
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表 2 输尿管皮肤造口患者吻合口狭窄影响因素的单因素分析
项目 例数 造口狭窄(44例) 狭窄率/% χ2 P值 项目 例数 造口狭窄(44例) 狭窄率/% χ2 P值 性别 0.008 0.927 尿常规尿比重 5.214 0.0222) 男 67 37 55.22 < 1.015 49 22 44.90 女 13 7 53.85 ≥1.015 31 22 70.97 BMI/(kg/m2) 1.4781) 0.556 手术类型 0.211 0.900 ＜18.5 1 0 0(0) 开腹手术 27 15 55.56 18.5~23.9 29 15 51.72 腹腔镜手术 37 21 56.76 ＞23.9 50 29 58.00 机器人手术 16 8 50.00 术前血清白蛋白浓度/(g/L) 1.980 0.159 术中植入导管型号 7.727 0.0052) < 40 49 30 61.22 F7 66 41 62.12 ≥40 31 14 45.16 F8 14 3 21.43 术前血红蛋白浓度/(g/L) 2.251 0.134 是否长期植入支架 4.630 0.0312) < 130 34 22 64.71 是 35 24 68.57 ≥130 46 22 47.83 否 45 20 44.44 T分期 0.132 0.716 定期更换支架周期/(次/月) 6.519 0.0112) T1~T2 55 31 56.36 1~2 50 22 44.00 T3~T4 25 13 52.00 >2 30 22 73.33 N分期 0.435 0.509 术后支架移除时间/d 3.682 0.055 N0 52 30 57.69 ≤4 13 4 30.77 N1~NX 28 14 50.00 >4 67 40 59.70 M分期 0.0211) 0.701 术后使用抗生素种类 1.164 0.281 M0 2 1 50.00 β-内酰胺类 56 33 58.93 MX 78 43 55.13 喹诺酮类 24 11 45.83 是否接受术前放疗 0.054 0.816 术后居家饮水量/mL 4.702 0.0302) 是 5 2 40.00 ＜2 000 44 29 65.91 否 75 42 56.00 ≥2 000 36 15 41.67 尿常规pH 5.304 0.0212) 术后居家饮食习惯 0.776 0.378 5.0~6.4 55 35 63.64 清淡 68 36 52.94 6.5~7.5 25 9 36.00 重口 12 8 66.67 尿常规尿糖 0.001 1.000 术后是否定期进行造口扩张a) 0.241 0.624 阳性 9 5 55.56 是 51 27 52.94 阴性 71 39 54.93 否 29 17 58.62 尿常规尿血红蛋白 1.014 0.314 定期清洗造口频率/(d/次) 13.968 0.0012) 阳性 68 39 57.35 1 35 11 31.43 阴性 12 5 41.67 ＞1 45 33 73.33 尿常规尿蛋白 3.589 0.058 术后更换造口袋频率/(d/次) 5.166 0.0232) 阳性 47 30 63.83 1~7 59 28 47.46 阴性 33 14 42.42 ＞7 21 16 76.19 尿常规尿白细胞 0.550 0.458 是否为瘢痕体质 8.729 0.0032) 阳性 63 36 57.14 是 13 12 92.31 阴性 17 8 47.06 否 67 32 47.76 注：a)扩张方法扩张造口时，常规消毒，以F8~F9小儿尿道扩张器涂石蜡油，缓慢插入造口至尿道扩张器2~3 cm处，停留3~5 min，也可放入小儿导尿管引流保持尿液的排空。1)Fisher精确值; 2)P < 0.05。
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表 3 输尿管皮肤造口患者吻合口狭窄影响因素的logistic回归分析
项目 回归系数 标准误 Wald χ2值 P值 OR值 95%CI 术前尿常规检验(pH) 1.341 0.687 3.806 0.051 3.824 0.994~14.713 术前尿常规检验(尿比重) -1.039 0.709 2.148 0.143 0.354 0.088~1.420 术中植入导管型号 -2.100 0.970 4.688 0.030 0.122 0.018~0.820 是否长期植入支架 0.142 0.743 0.036 0.849 1.152 0.268~4.946 定期更换支架导管 -0.926 0.670 1.913 0.167 0.396 0.107~1.471 术后居家饮水量 -0.381 0.678 0.315 0.574 0.683 0.181~2.581 定期清洗造口频率 -1.544 0.670 5.313 0.021 0.214 0.057~0.794 术后更换造口袋的频率 -1.205 0.787 2.346 0.126 0.300 0.064~1.401 是否为瘢痕体质 2.692 1.349 3.982 0.046 14.758 1.049~207.612 常量 1.344 3.244 0.174 0.677 3.833
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[1] Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi: 10.3322/caac.21660
[2] 刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读[J]. 肿瘤综合治疗电子杂志, 2021, 7(2): 1-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLZD202102001.htm
[3] 李宏召, 程强, 艾青, 等. 机器人全腔内Studer原位新膀胱术[J]. 现代泌尿外科杂志, 2021, 26(10): 807-811. https://www.cnki.com.cn/Article/CJFDTOTAL-MNWK202110001.htm
[4] Witjes JA, Bruins HM, Cathomas R, et al. European association of urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines[J]. Eur Urol, 2021, 79(1): 82-104. doi: 10.1016/j.eururo.2020.03.055
[5] Lenis AT, Lec PM, Chamie K, et al. Bladder cancer: a review[J]. JAMA, 2020, 324(19): 1980-1991. doi: 10.1001/jama.2020.17598
[6] O'Flynn S K. Care of the stoma: complications and treatments[J]. Br J Community Nurs, 2018, 23(8): 382-387. doi: 10.12968/bjcn.2018.23.8.382
[7] Cong J, Zhang H, Chen C. Definition and grading of anastomotic stricture/stenosis following low anastomosis after total mesorectal excision: A single-center study[J]. Asian J Surg, 2023, 46(9): 3722-3726. doi: 10.1016/j.asjsur.2023.03.027
[8] Yang DY, Boorjian SA, Westerman MB, et al. Persistent, long-term risk for ureteroenteric anastomotic stricture formation: the case for long term follow-up[J]. Transl Androl Urol, 2020, 9(1): 142-150. doi: 10.21037/tau.2019.09.05
[9] Tafuri A, Presicce F, Sebben M, et al. Surgical management of urinary diversion and stomas in adults: multidisciplinary Italian panel guidelines[J]. Minerva Urol Nephrol, 2022, 74(3): 265-280.
[10] 辛晓雷, 方林. 输尿管镜腔内治疗输尿管狭窄(附65例报告)[J]. 临床泌尿外科杂志, 2023, 38(3): 218-222. https://lcmw.whuhzzs.com/article/doi/10.13201/j.issn.1001-1420.2023.03.014
[11] 李柳林. 输尿管镜下逆行球囊扩张术治疗良性输尿管狭窄的40例临床资料分析[D]. 沈阳: 中国医科大学, 2019.
[12] Yang Y, Bai Y, Wang X, et al. Internal double-J stent was associated with a lower incidence of ureteroileal anastomosis stricture than external ureteral catheter for patients undergoing radical cystectomy and orthotopic neobladder: A systematic review and meta-analysis[J]. Int J Surg, 2019, 72: 80-84. doi: 10.1016/j.ijsu.2019.10.023
[13] Agrawal M, Gite V A, Sankapal P, et al. Retained ureteral stents, an avoidable source of morbidity: 10 years experience from a single tertiary care centre[J]. Pan Afr Med J, 2022, 42: 68.
[14] 黄秋霞, 王建宁, 汤利萍, 等. 输尿管皮肤造口患者单J管更换就诊延迟的质性研究[J]. 护理学杂志, 2018, 33(6): 34-36. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201806012.htm
[15] Stelton S. CE: Stoma and peristomal skin care: a clinical review[J]. Am J Nurs, 2019, 119(6): 38-45. doi: 10.1097/01.NAJ.0000559781.86311.64
[16] Wound, Ostomy and Continence Nurses Society. WOCN society clinical guideline: management of the adult patient with a fecal or urinary ostomy-an executive summary[J]. J Wound Ostomy Continence Nurs, 2018, 45(1): 50-58. doi: 10.1097/WON.0000000000000396
[17] Goh AC, Belarmino A, Patel NA, et al. A population-based study of ureteroenteric strictures after open and robot-assisted radical cystectomy[J]. Urology, 2020, 135: 57-65. doi: 10.1016/j.urology.2019.07.054
[18] 瞿春华, 瞿海红, 周花仙. 尿流改道腹壁造口术后病人延续护理的研究现状[J]. 护理研究, 2017, 31(26): 3221-3225. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201726002.htm
[19] Gray M, Kent D, Ermer-Seltun J, et al. Assessment, selection, use, and evaluation of body-worn absorbent products for adults with incontinence: a WOCN society consensus conference[J]. J Wound Ostomy Continence Nurs, 2018, 45(3): 243-264.
[20] 王双凤. 膀胱癌输尿管皮肤造口患者自我管理干预的效果研究[D]. 郑州: 郑州大学, 2019.
[21] 蔡景龙. 瘢痕疙瘩的诊疗指南建议[J]. 中国美容医学, 2016, 25(6): 38-40. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX201606018.htm
[22] 帕丽旦·热吉甫, 杨润清, 张媛, 等. PPH术后吻合口狭窄危险因素分析[J]. 中华结直肠疾病电子杂志, 2021, 10(5): 482-486. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHZC202105006.htm
[23] 苌恩强, 阮孝国, 李宁涛, 等. 瘢痕体质患者气管切开术后声门下气管狭窄的发生情况[J]. 中华麻醉学杂志, 2019(11): 1311-1314.
[24] 曹振东, 刘伟. 从全身性炎症角度审视瘢痕疙瘩发病机制和治疗策略[J]. 中华烧伤杂志, 2020(5): 334-338.
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