膀胱癌患者微创切除术后不同尿流改道方案的临床效果对比

Comparison of different urinary diversion regimens after minimally invasive resection for bladder cancer patients

摘要:

目的??探讨膀胱癌患者微创切除术后不同尿流改道方案的临床效果。方法?选取2010年1月-2015年6月该院泌尿科收治的肌层浸润型膀胱癌患者127例，根据患者的病情接受不同的尿流改道方案，将患者分为原位回肠膀胱术组58例，Bricker膀胱术组33例，输尿管皮肤造口术组36例，比较3组患者一般资料、临床资料、术后并发症和生活质量评分。结果?3组患者的性别比例、年龄分布以及肿瘤分期的差异无统计学意义；手术时间和术后住院时间，原位回肠膀胱术组长于其他两组，Bricker膀胱术组长于输尿管皮肤造口术组，差异均具有统计学意义；术中出血量，原位回肠膀胱术组多于其他两组，Bricker膀胱术组多于输尿管皮肤造口术组，差异均具有统计学意义，两两比较肠功能恢复时间，原位回肠膀胱术组与Bricker膀胱术组差异无统计学意义，输尿管皮肤造口术组时间短于其他两组，差异具有统计学意义；3组患者近期并发症发生率的比较，差异无统计学意义；原位回肠膀胱术组的远期并发症总比例明显高于其他两组，差异具有统计学意义；原位回肠膀胱术组患者社会功能评分、总体健康评分高于其他两组，差异具有统计学意义。结论?原位回肠膀胱术无需外接装置，更接近生理排尿特征，术后生活质量较高，但是远期并发症发生率较高，输尿管皮肤造口术后恢复快，并发症较少，适应不宜长时间手术的患者。应根据患者个体状况选择合适的手术方式。

Abstract:

Objective?To investigate the clinical effects of different urinary diversion regimens after minimally invasive resection of bladder cancer.?Methods?127 patients with muscular infiltrating bladder cancer from January 2010 to June 2015 were enrolled in this study. According to the patients’ condition, they were divided into orthotopic ileal cystectomy group (58 cases), Bricker bladder surgery group (33 cases), ureteral skin ostomy group (36 cases), then compare the clinical data, postoperative complications and quality of life of the three groups.?Results?There was no significant difference in the ratio of sex, the distribution of age and tumor staging among the three groups. The operation time and postoperative hospital stay in orthotopic ileal cystectomy group were longer than those in the other two groups. The operation time and postoperative hospital stay of the Bricker bladder surgery group were longer than that in ureteral skin ostomy group, the difference was statistically significant; the bleeding in orthotopic ileal cystectomy group was more than the other two groups, and in Bricker bladder surgery group was more than ureteral skin ostomy group, the difference was statistically significant. There was no significant difference in the recovery time of intestinal function among the three groups. The recovery time of intestinal function in ureteral skin ostomy group was shorter than that in the other two groups, the difference was statistically significant. There was no significant difference in the incidence of short-term complications of the three groups of patients. The incidence of long-term complications of orthotopic ileal cystectomy group was significantly higher than the other two groups, the difference was statistically significant. The social function scores, and overall health score of orthotopic ileal cystectomy group were higher than the other two groups, the difference was statistically significance.?Conclusion?Without external device, closer to the characteristics of physiological urination, orthotopic ileal cystectomy holds higher postoperative quality of life, and higher incidence of long-term complications. With advantages of quick recovery and less complications, ureteral skin ostomy is best for patients who can not stand for long time surgery. It should choose the appropriate surgical approach for patients according to individuals’ conditions.