Analysis Of The Clinical Efficacy And Complications Of Uretero Mesenteric Subserosal Tunnel Posterior Wall Anastomosis In Sigmoid Orthotopic Neobladder

Objective(s):Describe an improved technique of ureter and bowel anastomosi s(i.e.ureter mesenteric subserosal tunnel bladder posterior wall anastomosis),ev aluate its clinical efficacy,and investigate the incidence of postoperative compli cations.Methods:The subjects of this study were patients who underwent sigmoid neo bladder surgery and used ureteral mesenteric subserosal tunnel bladder posterior wall anastomosis in the Department of Urology,Second Affiliated Hospital of Kunming Medical University from 2016 to 2020.All the subjects were diagno sed as bladder cancer by preoperative pathological biopsy,and no distant metas tasis was found by imaging examination.The general condition was good,and there was no obvious surgical contraindication.The operation was performed by the same group of urologists.Except for 3 patients with missing follow-up and incomplete clinical data,a total of 46 patients were included in this study,including 41 males(87%)and 5 females(13%).The perioperative and postop erative complications were collected retrospectively.SPSS 22.0 statistical softwa re was used to analyze and process the data.The measurement data of normal distribution were expressed as mean± standard deviation(x±s),the measu rement data of non normal distribution were expressed as median(lower quartil e to upper quartile);the count data were expressed as percentage(%).Results:In this study,the follow-up time was 4-59 months(mean 34 months).All the 46 patients were operated successfully,and there was no intraoperative and perioperative death.The average operation time was 5.06(5.0-6.0)h,intraoperative blood loss was 400(300-725)ml,postoperative antibiotic use time was 12.9±4.8 d.The postoperative ureteral single "J"tube indwelling time is 15(13.8-15.0)d,postoperative urinary catheter indwelling time was 20.8 ± 3.5 d,and postoperative hospital stay was 22.6±6.1 d.Among the 46 patients,1 patient had tumor recurrence after operation and continued to receive chemotherapy.There was no death during the follow-up period.Early complications occurred in 52.2%of the patients after operation,among which the most common complication was urogenital system(about 30.4%),followed by infection(26.1%)and gastrointestinal complications(23.9%),among which severe complications(grade 3-5)accounted for 4.3%.The incidence of late postoperative complications was(19.6%),of which genitourinary complications(17.4%)were the most common.The main complications associated with ureterojejunostomy included urinary tract infection in 9 cases(19.6%),early ureteral obstruction in 6 cases(13.0%),acute kidney injury in 5 cases(10.7%),ureterojejunostomy leakage in 1 case(2.2%),ureterojejunostomy stenosis in 4 cases(8.7%),upper urinary tract calculi in 1 case(2.2%),chronic renal insufficiency in 2 cases(4.3%)and late ileus in 1 case(2.2%).Conclusion(s):The clinical effect of ureter mesenteric subserosal tunnel bladder posterior wall anastomosis in sigmoid orthotopic neobladder is good,and it has similar safety with conventional anastomosis in technology.The incidence of ureteroenteral anastomotic stricture and late intestinal obstruction is low after operation,and ureteroenteric subserosal tunnel bladder posterior wall anastomosis makes the new bladder more close to the physiological shape,which is easy for postoperative cystoscopic review and complications management.