探讨杂交以及Keyhole2种方式治疗回肠代膀胱造口疝相关并发症的比较研究。

收集2013年1月至2018年1月，首都医科大学附属朝阳医院京西院区住院治疗的回肠代膀胱术后并发造口疝30例患者的临床资料，其中杂交法组14例，Keyhole组16例。比较其术前、术后第1天、术后1周肌酐变化，统计术后泌尿外科相关并发症发生率等。

杂交法组与Keyhole组在年龄、体质量指数、术前血肌酐、术后1周血肌酐、回肠膀胱术后至出现造口疝时间、出现造口疝至手术时间、疝囊大小、疝环大小、住院时间，术中出血量比较，差异均无统计学意义（P>0.05）。杂交法组手术时间明显长于Keyhole法组，杂交法组术后第1天血肌酐明显高于Keyhole组，差异均有统计学意义（P<0.05），但2组术后1周血肌酐水平比较，差异无统计学意义（P>0.05）。双肾积水发生率Keyhole组为0%，杂交法组为21%（3/14）；其中术后7 d内有2例患者出现双肾积水，均于回肠膀胱造口留置尿管后解除；1例患者术后2个月出现双肾积水，通过双肾穿刺造瘘后解除尿路梗阻。

对于回肠代膀胱术后并发造口疝患者，杂交法及Keyhole均为有效手术治疗方式，杂交法较Keyhole法出现术后短期一过性肌酐升高及肾积水的概率更高，但经保守治疗大部分可于短期内缓解，故推荐使用Keyhole法治疗回肠代膀胱造口疝。

To evaluate the clinical outcome and urological complications of Keyhole surgery and hybrid technique in the treatment of paraileostomal herniorraphy.

A retrospective analysis of 30 cases of paraileostomal herniorraphy after radical cystectomy in Beijing Chao-Yang Hospital from January 2013 to January 2018 was conducted, including 16 cases with Keyhole approaches and 14 cases with hybrid technique. Clinical effects and characteristics and the serum creatinine level of pre/post-operative were compared.

Two approaches showed no significant differences in age BMI, pre-operative serum creatinine level, post-operative serum creatinine level at 1 week, the duration time of hernia history, the duration time of hernia occurrence to surgery, size of hernia sac, length of hernia, hospitalization time, volume of intraoperative blood loss. Operation time in hybrid group was apparently longer than that in Keyhole group (P<0.05). Serum creatinine level at 1 d after operation showed significant difference between two approaches, and hybrid group were higher than Keyhole group. Bilateral hydronephrosis was not observed in Keyhole group. The incidence of two bilateral hydronephrosis was 3/14 in hybrid group: 2 patients occurred within first week after surgery. The bilateral hydronephrosis were relieved after catheter placement. 1 patient was diagnosed bilateral hydronephrosis at 2 months after surgery, which relieved by bilateral percutaneous nephrostomy.

Hybrid and Keyhole approaches were both effective approaches for paraileostomal herniorraphy, hybrid group are more likely to have bilateral hydronephrosis and short-term increased serum creatinine level after surgery, and however it can be resolved through the effective treatment in short time. We suggest that the serum creatinine level should be monitored at least one week after surgery. If the hydronephrosis were observed it should be resolved properly.