腹腔镜与开放性膀胱全切并全去带乙状结肠新膀胱术疗效比较

Comparation of the therapeutic effects of laparoscopic radical cystectomy (LRC-NB) and open radical cystectomy (ORC-NB) with orthotop sigmoid colon neobladder

目的:比较腹腔镜与开放性手术施行膀胱全切除并全去带乙状结肠新膀胱术的疗效。方法:对2000年2月至2006年12月施行的膀胱全切除并全去带乙状结肠新膀胱术85例患者进行围手术期评估,根据手术方法不同分为腹腔镜组(A组,41例)和开放手术组(B组,44例);对两种术式的手术方法、手术时间、术中出血量、术后疗效、住院期间并发症以及术后住院时间进行比较分析。结果:平均手术时间A组456.88min,B组398.86min。术中平均出血量A组534mL,B组831mL。术后肠道功能恢复时间A组3.56d,B组4.32d,两组手术组织切缘均无肿瘤。盆腔淋巴结清扫阳性率A组2.4%(1例),B组6.8%(3例)。住院期间并发症(近期并发症),A组总并发症发生率19.5%,B组总并发症发生率27.3%。A组有1例围手术期死亡。结论:腹腔镜膀胱全切并全去带乙状结肠新膀胱术比开放性手术出血少,肠道功能恢复快,并发症少,但手术时间较长。

Objective To compare the therapeutic effect of laparoscopic radical cystectomy （LRC-NB） and open radical cystectomy （ORC-NB） with orthotop sigmoid colon neobladder. Methods Eighty-five patients were evaluated including 41 undergoing LRC-NB （ Group A） and 44 ORC-NB （ Group B） from Febrary 2000 to December 2006 at our institution. The parameters for analysis included operative time, surgical method, blood loss, therapeutic effect, complications and hospital stay. Statistics included t-test and X^2-test （P 〈 0.05 was considered statistically significant）. Results There was no significant difference in factors of patients at baseline between both groups. The mean operative time was 456.88 rain in Group A vs 398.86 min in Group B. The mean intraoperative blood loss was 534 mL in Group A vs 831 mL in Group B. The mean recovery time of intestinal function was 3.56 d in Group A vs 4.32 d in Group B. The positive rates of pelvic ymphadenectomy was 2.4% （ 1 case） in Group A and 6.8% （3 cases） in Group B. The complication rate of Group A was 19.5%. By contrast, the complication rate of Group B was 27.3%. Group A had one case of perioperative death. Conclusion LRC-NB has better superiority than ORC-NB, showing fewer blood loss and surgical complication and sooner intestinal function, and then needing longer surgical time.