Study On The Effect Of Continuous Anastomosis Of Ureteral Neobladder Mucosa To Ureteral Neobladder Mucosa Under Laparoscopy

Objective To investigate the effect of ureteral neobladder mucosa-to-mucosal anastomosis on postoperative recovery of postoperative anastomotic fistula,ureteral reflux,anastomotic stenosis,renal function and complications in patients undergoing laparoscopic ileocustectomy.Methods Retrospective analysis was performed on the data of patients who underwent laparoscopic radical resection of ileal bowel cancer combined with orthotopic ileal neobladder from January 2014 to December 2018.By excluding hypertension,diabetes,urinary tract infection and other factors that may affect renal function,45 cases of patients with ureteral neobladder anastomosis using mucus-mucosa(mucosal group)and 11 cases of patients with ureteral neobladder anastomosis using nipple method(papillary group)were screened.Preoperative and postoperative improvement of creatinine and glomerular filtration rate,short-term anastomotic fistula,peritoneal effusion,anastomotic stenosis,incidence of ureteral reflux,and postoperative complications were compared between the two groups.Data were retrospectively collected and statistically analyzed using SPSS 20.0.Results In this study,there were 56 patients,including 54 males and 2 females,aged from 43 to 80 years,with an average age of(61.46±7.97)years.The operation was completed successfully in both groups,and there was no intraoperative transfer to open.Postoperative renal function in both groups was improved compared with that before surgery.In the mucosal group,the preoperative creatinine was 138.06±47.65mol/L,and the preoperative glomerular filtration rate was54.52±23.87ml/min/m2.Postoperative creatinine was 106.76±31.24 mol/L,and postoperative glomerular filtration rate was 67.37±25.80ml/min/m2(p< 0.01).In the nipple group,preoperative creatinine was 127.05±42.26 mol/L,and preoperative glomerular filtration rate was 42.87±10.44ml/min/m2.Postoperative creatinine was113.24±34.05 mol/L,and postoperative glomerular filtration rate was47.64±12.40ml/min/m2(p< 0.01).There were 2 cases(4.44%)of uretero-anastomotic fistula,4 cases(8.89%)of peritoneal effusion,1 cases(2.22%)of anastomotic stenosis and 3 cases(6.67%)of ureteral reflux.There were 4 cases(36.36%),2 cases(18.18%)of peritoneal effusion,3 cases(27.27%)of anastomotic stenosis and 2 cases(18.18%)of ureteral reflux fistula in the postoperative nipple group.Postoperative complications such as abdominal hemorrhage,peritonitis and intestinal anastomotic obstruction were not found in the two groups.Conclusion New bladder mucosa of mucosal anastomosis,ureter is laparoscopic joint in situ ileum new bladder and bladder cancer effect a radical cure of ureteral anastomosis in accordance with safe and reliable way,to improve the postoperative patients with renal function,reduce postoperative anastomotic fistula,anastomotic stricture,ureteral reflux incidence and long-term complications,such as has a good effect.