腹腔镜与开放膀胱根治性切除-原位回肠新膀胱术的近期疗效比较

Comparison of the Short-term Clinical Efficacy of Laparoscopic and Open Surgery for Radical Cystectomy with Orthotopic Ileal Neobladder

目的研究比较腹腔镜与开放性膀胱根治性切除-原位回肠新膀胱术治疗浸润性膀胱癌的近期疗效。方法回顾分析我院施行的40例膀胱根治性切除-原位回肠新膀胱术患者的临床资料,根据手术方式不同分为腹腔镜组18例和开放组22例。比较两种术式的围术期情况、术后并发症、新膀胱功能及肿瘤控制效果等指标。结果腹腔镜组18例手术均获得成功,无中转开放。腹腔镜组平均手术时间明显长于开放组,两组比较差异有统计学意义(P<0.05);术中平均出血量、平均肠道功能恢复时间、平均住院时间明显少于开放组,两组比较差异有统计学意义(P<0.05);腹腔镜组术后并发症发生率较低(P<0.05)。新膀胱功能在膀胱容积、膀胱内压、最大尿流率及残余尿方面无统计学意义(P>0.05)。术后12个月日间/夜间尿控率相当(P>0.05)。随访12～24个月,开放组1例尿道复发,腹腔镜组无肿瘤复发及转移。结论腹腔镜下膀胱根治性切除-原位回肠新膀胱术不仅具有出血少,肠道功能恢复快,住院时间短、并发症少等优点,而且术后控尿效果及近期肿瘤根治效果与开放手术相当,但手术时间仍较长,远期肿瘤根治效果需要进一步随诊观察。

Objective To compare the short-term clinical efficacy of laparoscopic radical cystectomy （LRC） with orhtotopic ileal neobladder and open radical cystectomy （ORC）with orhtotopic ileal neobladder as the treatment of invasive bladder cancer. Methods A total of 40 patients were evaluated including 18 ca- ses with LRC and 22 cases with ORC in our hospital. The parameters analyzed included perioperative data, postoperative complications, new bladder function and effect of tumor control. Results 18 cases of patients undergoing LRC group were all successful, no patient converted to open surgery. The mean operating time of LRC group was longer than ORC group. There was statistical difference between the LRC group and ORC group（ P 〈 0.05 ）. The mean blood loss, oral intake after operation and hospitalize time after operation of LRC group were less than ORC group（P 〈0.05） ;complication incidence after operation of LRC group was lower （ P 〈 0.05 ）. There was no significant difference of VOL, maximum flow rate and residual urine of neobladder between these 2 groups（P 〉 0.05 ）. 12 months after the surgery day/night urine controlling rate is similar （ P 〉 0.05 ）. Follow-up of 12 to 24 months, 1 urethral recurrence in ORC group, no tumor recurrence and me- tastasis in LRC group. Conclusion LRC not only has the advantages of less blood loss, shorter oral intake time and hospital stay, less postoperative complications, but also comparable continent rate and short-term tumor control effect with ORC. However, it has the disadvantage of more operation time, and long-term follow- up is needed to confirm the tumor control effect.