女性膀胱癌患者原位回肠和乙状结肠尿流改道效果的比较(英文)

Comparison of clinical efficacy between orthotopic ileal neobladder and orthotopic sigmoid neobladder in female bladder cancer patients

背景:原位尿流改道在膀胱癌根治术后具有良好的控尿能力,但针对女性膀胱癌患者行原位回肠重建新膀胱和原位乙状结肠重建新膀胱后疗效及随访方面的研究很少。目的:比较女性膀胱癌患者原位回肠和乙状结肠尿流改道的临床疗效。方法:回顾性分析 1996 至 2008 年行膀胱癌术后原位回肠尿流改道(回肠组,n=29)和乙状结肠尿流改道(乙状结肠组,n=23)的女性膀胱癌患者的临床资料。比较分析两组患者修复中及修复后的一般情况、尿动力学结果、控尿能力和修复后储尿囊相关并发症等。结果与结论:平均随访时间回肠组 57 个月,乙状结肠组 55 个月。两种修复方式术中失血量、术后控尿效果接近,但两组在手术时间、治疗后下床时间、新膀胱容量等方面差异有显著性意义(P < 0.05)。回肠组治疗后早期及晚期储尿囊相关并发症发生率均高于乙状结肠组。回肠组治疗后储尿囊再发肿瘤 2 例,乙状结肠组未见发生,说明两种重建方式应用于女性膀胱癌患者疗效均良好。

BACKGROUND： The orthotopic urinary diversion after radical cystectomy of bladder cancer has good urinary continence. However, there are few reports about the clinical efficacy and follow-up of orthotopic ileal neobladder and orthotopic sigmoid neobladder in female bladder cancer patients. OBJECTIVE： To compare the clinical efficacy of orthotopic ileal neobladder and orthotopic sigmoid neobladder in female bladder cancer patients. METHODS： The clinical data of the female patients with bladder cancer who were treated with orthotopic ileal neobladder （ileal group, n=29） and orthotopic sigmoid neobladder （sigmoid group, n=23） from 1996 to 2008 were retrospective analyzed. The intraoperative and postoperative conditions, urodynamics, urinary continence, pouch-related complications of the patients in two groups were compared. RESULTS AND CONCLUSION： The average follow-up time was 57 months in the ileal group, and 55 months in the sigmoid group. There was no difference in intraoperative blood loss and postoperative urinary continence between two groups, and there were significance differences in operative time, postoperative out-of-bed activity and the orthotopic neobladder’s capacity between two groups （P 0.05）. The early and late pouch-related complication rates in the ileal group were higher than those in the sigmoid group. In the ileal group, tumor recurred in two patients, and no tumor recurred in the sigmoid group. It indicates that orthotopic ileal neobladder and orthotopic sigmoid neobladder in female patients are both safe and effective to achieve satisfactory clinical outcomes.