回肠膀胱术与原位回肠新膀胱术的临床比较研究

Ileal Conduit vs Orthotopic Ileal Neobladder after Radical Cystectomy in Patients with Bladder Cancer:A Clinical Retrospective Study

目的探讨分析全膀胱切除术后2种尿流改道术式的临床效果及并发症。方法回顾分析我科从2003年5月至2009年12月间126例膀胱癌全膀胱切除患者(其中行回肠膀胱术45例,原位回肠新膀胱术81例)的临床资料、手术近、远期并发症,并进行比较研究。结果回肠膀胱术组的尿瘘、不全肠梗阻、手术时间、平均住院天数、对上尿路的损害及围手术期死亡率均明显低于原位回肠新膀胱术组,差异均具有统计学意义(P<0.05)。2组在手术出血量[(365±37)mL与(395±63)mL]方面差异无统计学意义(P>0.05)。结论回肠膀胱术与原位回肠新膀胱术都是较好的膀胱全切术后尿流改道方式,但回肠膀胱术因操作相对简单、并发症少,应为高龄及合并基础疾病患者的优先选择。

Objective To compare the clinical effects and surgical complications of ileal conduit and orthotopic ileal neobladder in the patients who underwent radical cystectomy. Methods Retrospective analysis clinical data, surgical complications of short and long-term of 126 patients with radical cystectomy for bladder cancer （45 with ileal conduit and 81 with orthotopic ileal neobladder） in our hospital during the past 6 years. Results Urinary fistula, incomplete intestinal obstruction, operation time, average hospital stay, upper urinary tract damage and perioperative mortality rates in ileal neobladder group were significandy lower than that of the orthotopie ileal neobladder groups （ P 〈 0.05 ）. No demonstrable difference was found in blood loss （365 ＋- 37 mL and 395 ＋- 63 mL）between the two groups （P 〉 0.05 ）. Conclusion The ileal conduit and orthotopic ileal neobladder are both good forms of urinary diversion, but ileal ueobladder due to relatively simple, less complications, should be preferred surgical approach for the elderly and patients with underlying diseases.