回肠代膀胱与回肠膀胱术的比较及早期并发症探讨

Comparative study of two different urinary diversion operations -orthotopic neobladder and ileal conduit

目的 探讨膀胱肿瘤患者膀胱全切术后行回肠代膀胱术与回肠膀胱术的临床治疗效果及术后早期并发症。方法 分析 13 5例膀胱肿瘤患者行膀胱全切术后采用回肠代膀胱术 86例与回肠膀胱术 49例的临床资料 ,就两种术式手术时间、术中出血量、术后早期并发症、平均住院日、再手术率及死亡率等指标进行比较分析。结果 除手术操作时间回肠代膀胱术组 (平均 3 46min)长于回肠膀胱术组 (平均 2 70min)外 ,回肠代膀胱与回肠膀胱术组在术中平均出血量 (660ml与 62 7ml)、术后早期并发症发生率 (18.6%与 16.3 % )、患者平均住院日 (4 7d与 41d)、再手术率 (8.1%与6.1% )及死亡率 (1.2 %与 2 .0 % )等方面差异无显著性 (P >0 .0 5 )。结论 回肠代膀胱术是膀胱全切术后膀胱替代的理想术式 ,具有手术安全 ,术后早期并发症少 ,可自主性控制排尿 ,明显提高患者的生活质量而易于接受 。

Objective To compare the clinical value and early complications of patients who underwent radical cystectomy with ileal conduit versus continent orthotopic neobladdder.Methods A retrospective review was done on 135 patients with transitional cell carcinoma of bladder,86 patients with orthotopic reconstruction and 49 patients with ileal conduit during a 9-year time frame.Parameters associated with the surgical procedures (operative time,amount of bleeding during operation),the hospital stay,morbidity,reoperative rates and mortality were compared between the two groups.Results In the orthotopic neobladder group and the ileal conduit group,the median operative time was 346 min and 270 min,the median blood loss was 660 and 627 ml,the mean hospital stay was 47 days and 41 days,reoperative rate was 8.1% and 6.1%,and the perioperative mortality was 1.2% and 2.0%,respectively.No demonstrable difference in morbidity or perioperative complications was found between the two procedures in our review.Conclusion Compared to ileal conduit procedure,the continent orthotopic neobladder is a safe and viable procedure,and it offers a better quality of life with acceptable complications and advocates its use when possible for bladder substitution in the patients with bladder carcinoma.