腹腔镜下膀胱根治性全切与开放手术的近期临床疗效比较

Short-term clinical efficacy comparison of laparoscopic and open radical cystectomy for management of bladder cancer

目的比较腹腔镜下根治性膀胱全切术与传统开放手术的近期临床疗效。方法回顾性分析2010年10月至2013年8月郑州大学第一附属医院30例腹腔镜下根治性膀胱切除术及同期37例开放手术患者的围术期、术后恢复及术后并发症情况，并对其进行分析比较。结果腹腔镜组与开放组在年龄、性别上比较差异无统计学意义（P〉0．05）。腹腔镜组平均手术时间为310．2rain，开放组为306．8min（P〉0．05）。腹腔镜组术中出血量、术后输血率、肛门排气时间、进食时间、术后并发症发生率及术后住院时间分别为537．6ml、5．6％、4．5d、5．5d、8．3％、lld，而开放组分别为910．3ml、18．5％、5．6d、7d、27．8％、15d。两组在切缘阳性率上比较差异无统计学意义（P〉0．05）。结论腹腔镜下根治性膀胱全切术具有出血少、恢复快、并发症少和住院时间短等优点，安全可行，近期疗效满意。

Objective To compare the short-time clinical effects of laparoscopic radical cystecto- my（LRC） and open radical cystectomy. Methods From October 2010 to August 2013, 67 patients in our hospital underwent radical cystectomy for bladder cancer. A total of 30 patients were treated by lapa- roscopy and 37 patients were treated by open surgery. The parameters were analyzed, including perioper- ative data, postoperative recovery and complications. Results There were no significant differences in age or sex between laparoscopic surgery group and open surgery group （ P 〉 0, 05 ）. The mean operating time was 310. 2 min in LRC group, and 306. 8 min in ORC group （P 〉0. 05）. The mean blood loss, the incidence of postoperative transfusion, anal exhausting time, resumption time of oral intake, the inci- dence of complications and the time of mean hospital stay were 512.6 ml, 5.6% , 4.5 d, 5.5 d, 8.3% , 11 d in LRC group and 620. 3 ml, 18.5% , 5.6 d, 7 d, 27. 8% , 15 d in ORC group （P 〈0. 05） , re-spectively. There was no significant difference in the excision margin positive rate between the two groups （ P 〉 0. 05 ）. Conclusions LRC is secure and effective for bladder cancer, and it has the advantages of less blood loss during operation, quicker recovery of bowel function, less complica- tions, shorter hospitalization, and satisfactory short-term outcome.