腹腔镜与开放手术方式根治性膀胱切除术治疗膀胱癌的临床研究

Clinical comparison of laparoscopic and open surgery for radical cystectomy

摘要:

目的  通过回顾性分析腹腔镜与开放手术方式根治性膀胱切除术（RC）治疗膀胱癌的临床观察指标，评价腹腔镜技术在RC治疗膀胱癌中的临床价值。方法  2009年10月-2014年8月该院实施RC患者49例，其中腹腔镜组20例（A组）、开放组29例（B组）。收集两组患者的临床资料，采取术中出血量、手术时间、术后胃肠功能恢复时间、术后住院天数和术后并发症等作为观察指标。计量资料采用均数±标准差（x±s）表示，组间比较资料采用t检验，计数资料采用百分率表示，组间比较采用χ2检验，P <0.05为差异有统计学意义。结果  平均术中出血量A组低于B组[（416.66±232.73）ml vs （964.16±445.73）ml，P <0.05]；平均术后住院时间A组低于B组[（14.93±2.72）d vs（19.50±3.16）d，P <0.05）]；术后并发症A组少于B组（P <0.05）；平均手术时间、平均术后肠功能恢复时间两组间差异无统计学意义。结论  通过分析两组临床观察指标，腹腔镜根治性膀胱切除术（LRC）治疗膀胱癌，在手术效果方面与开放手术相似，但其具有创伤小、失血少、恢复快和术后并发症相对较少等优点，是一种安全、有效的手术方法。远期疗效尚需要更多病例术后随访。

Abstract:

Objective To evaluated the clinical value of laparoscopic techniques in radical cystectomy surgery for the treatment of bladder cancer. Methods Clinical data of 49 patients underwent radical cystectomy with Bricker ileal conduit diversion were retrospectively analyzed from October 2009 to August 2014, which laparoscopic radical cystectomy with Bricker ileal conduit 20 cases (Group A), open radical cystectomy with Bricker ileal conduit 29 cases (Group B). The blood loss during operation, operating time, gastrointestinal function recovery after operation, hospital stay after operation and complications were observed between the two groups. Results The blood loss during operation was significantly lower in Group A (416.66 ± 232.73) ml than in Group B (964.16 ± 445.73) ml (P < 0.05), and hospital stay after operation was significantly lower in Group A (14.93 ± 2.72) days than in Group B (19.50 ± 3.16) days (P < 0.05), complication after operation was significantly lower in Group A than in Group B (P < 0.05). The operating time and gastrointestinal function recovery has no significantly difference between the two groups. Conclusions Laparoscopic radical cystectomy have advantages of minimal invasion, less blood loss, rapid recovery and less postoperative complications. It is a safe and effective surgical method. Long term effect need evaluated by follow up.