Introduction: Pelvic exenteration is a radical operation for advanced or recurrent pelvic malignancies, requiring urinary and faecal diversion. The ileal conduit (IC) remains the standard urinary diversion, while the double-barrel uro-colostomy (DBUC) has re-emerged as an alternative that avoids small bowel anastomosis and consolidates diversion into a single stoma. Aims: To evaluate comparative outcomes of DBUC versus IC to clarify relative risks and potential benefits. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251090885). PubMed, Scopus, EMBASE, and Medline were searched to March 2025 for studies directly comparing DBUC and IC following pelvic exenteration. Eligible studies reported perioperative or urological outcomes. Results: Four retrospective studies (164 patients; DBUC 88, IC 73) were included. Urinary leak was lower with DBUC (10.2% vs. 15.1%), with pooled analysis showing a higher risk in IC (RR 2.52, 95% CI 1.02–6.20,p= 0.04). Pyelonephritis (42.0% vs. 15.3%; RR 1.37,p= 0.24) and electrolyte derangements (20.6% vs. 15.6%; RR 1.21,p= 0.64) did not differ significantly. Rates of urinary and enteric fistulas were similar. Clavien–Dindo grade III (42.1% vs. 37.1%) and grade IV complications (17.1% vs. 24.2%) were also comparable between groups. Conclusion: DBUC is a feasible alternative to IC after pelvic exenteration, with reduced urinary leak rates and comparable morbidity. Its single-stoma approach may offer patient-centred advantages. Larger prospective studies incorporating long-term and quality-of-life outcomes are needed.
引言：盆腔廓清术是治疗晚期或复发性盆腔恶性肿瘤的根治性手术，需同时进行尿流和粪流改道。回肠膀胱术仍是标准的尿流改道方式，而双筒式尿路结肠造口术作为一种替代方案重新受到关注，该术式可避免小肠吻合，并将两种改道整合为单一造口。目的：通过评估双筒式尿路结肠造口术与回肠膀胱术的临床结局，明确其相对风险与潜在获益。方法：本研究按照PRISMA指南开展系统综述与荟萃分析，并在PROSPERO平台注册（注册号CRD420251090885）。检索截至2025年3月的PubMed、Scopus、EMBASE和Medline数据库中直接比较盆腔廓清术后双筒式尿路结肠造口术与回肠膀胱术的研究。纳入标准为报告围手术期或泌尿系统结局的研究。结果：共纳入4项回顾性研究（164例患者；双筒式尿路结肠造口术88例，回肠膀胱术73例）。双筒式尿路结肠造口术的尿漏发生率较低（10.2% vs. 15.1%），合并分析显示回肠膀胱术的尿漏风险更高（相对风险2.52，95%置信区间1.02–6.20，p=0.04）。肾盂肾炎（42.0% vs. 15.3%；相对风险1.37，p=0.24）与电解质紊乱（20.6% vs. 15.6%；相对风险1.21，p=0.64）发生率无显著差异。尿路与肠道瘘发生率相近。两组在Clavien–Dindo III级（42.1% vs. 37.1%）和IV级并发症（17.1% vs. 24.2%）方面亦具有可比性。结论：双筒式尿路结肠造口术可作为盆腔廓清术后回肠膀胱术的可行替代方案，其尿漏发生率更低且总体并发症风险相当。该术式的单造口设计可能为患者带来临床获益。未来需要纳入长期结局与生活质量评估的大规模前瞻性研究加以验证。
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