Application Of Ileal Abdominal Wall Ostomy (Bricker Operation) In Urinary Diversion Of Bladder Cancer

Bladder cancer,in our country the incidence of urinary tract tumor,occupied the first,and only after prostate cancer was second in the Europe and the United State.For muscle invasive bladder cancer,high-grade non muscle invasive bladder cancer,the radical cystectomy(new bladder reconstruction)/bilateral pelvic lymph node dissection and urinary diversion still is the preferred measure,and has achieved certain curative effect in clinic,but the postoperative urinary bladder function and how to replace the diversion way there is no standard treatment plan,the Bricker operation is a classic way of urinary diversion,has the advantages of simple operation,less complications.With the gradual improvement of the operation style of Department of Urology physicians,its clinical worthy of application is further reflected.Objective: At present,with the reconstruction of in situ controllable bladder,because of its almost normal reduction of urinary tract anatomy and function,by patients and Department of Urology physician attention.Bricker operation has gradually been a replaced,ignored the trend.In this study,we analyzed the clinical treatment of bladder cancer patients with total cystectomy(Bricker),which showed that Bricker has important application value in the treatment of bladder cancerMethods : Methods the clinical data of 42 patients with bladder cancer who underwent total cystectomy and bladder cancer from January 2013 to January 2017 were retrospectively analyzed,including: the patient's general condition,clinical manifestation,preoperative imaging examination,preoperative cystoscopy and preoperative pathological staging.According to different conditions of patients,postoperative recovery,postoperative complications,follow-up period of limited long-term complications and stoma related conditions;at the same time combined with the related literature,the common analysis of Bricker for the recovery effect and clinical application value in the treatment of bladder cancer after surgery.Results: the study cases,of which 18 were laparoscopic Bricker surgery,24 cases of robot assisted laparoscopic surgery.Recent complications: 0 cases of intraoperative blood transfusion;postoperative intestinal obstruction in 5cases;7 cases of postoperative infection;1 cases of urinary fistula;postoperative bleeding in 0 cases;1 cases of deep vein thrombosis;there were 0cases of cardiovascular disease;intestinal fistula in 0 cases.The late complications: 2 cases of tumor recurrence;5 cases of renal damage;ureteral anastomotic stenosis in 4 cases;10 cases of fistula lesions.It is worth mentioning: case studies in 3 cases of patients before undergoing orthotopic bladder reconstruction,intraoperative findings in goiter tumor invasion of the urethra,intraoperative modification of the operation mode for the Bricker operation.Complications of patients in hospital were discharged after rehabilitation,long-term complications in patients with conservative treatment were improved,most of the cases of postoperative quality of life satisfaction.Conclusion: Bricker surgery in patients with bladder cancer can achieve remarkable curative effect and has higher security,less postoperative complications.According to the relevant literatures.There was no difference in the effect of the treatment of orthotopic ileal neobladder with Bricker.and wasno significant difference in the short-term complications during and after operation.However,Bricker is the only treatment for patients with positive margins,severe urethral sphincter dysfunction,urethral stricture,and liver and kidney dysfunction.At the same time,the complications of upper urinary tract after orthotopic neobladder were higher than those of ileal neobladder(Bricker),including the damage of renal function,urinary tract infection and urinary tract stones.To draw the following conclusions: 1)The orthotopic neobladder patients with contraindications,Bricker bladder surgery is the first choice of operation;2),patients with chronic diseases,especially in patients with renal insufficiency,can first consider the Bricker of bladder;3),For patients with poor medical and poor economic conditions,Bricker's bladder surgery is superior to in situ new bladder surgery.Therefore,we believe that Bricker still plays an irreplaceable role in the surgical treatment of bladder cancer,and it is still of great value in clinical practice.