膀胱癌原位新膀胱术后远期并发症观察

Long-term complications of neobladder after radical cystectomy of bladder cancer

目的了解膀胱癌原位新膀胱术后远期并发症的发生情况并进行分析。方法对于昆明医科大学第二附属医院泌尿外科接受膀胱癌膀胱全切+原位新膀胱术的88例患者进行随访。了解其术后远期并发症发生情况,并进行总结分析。结果术后随访期间共发生肾积水12例(13.6%),肾功能不全9例(10.2%),新膀胱尿道吻合口狭窄12例(13.6%),复发转移13例(14.8%),死亡14例(15.9%),肿瘤相关死亡率8%。尿失禁21例(23.9%),术后尿失禁发生率与性别、年龄无相关性;随访期在1年内与随访期超过1年者尿失禁发生率无统计学差异;60岁以上组与60岁以下组死亡率无统计学差异。3年存活率90.5%(38/42),5年存活率70%(14/20)。结论膀胱癌原位新膀胱术后远期效果理想,肿瘤相关死亡率较低,肾功能衰竭是重要的患者死亡原因,术后尿失禁的发生与性别年龄无相关性,尿失禁发生率在术后1年内达到稳定,在随访期内患者死亡率与年龄无明显相关性。

Objective To observe the long-term complications of neobladder after radical cystectomy of bladder cancer. Methods A total of 88 patients who receivedoperation of neobladder after radical cystectomy of bladder cancer in our depart- ment were followed up, and the long-term complications were observed and analyzed. Results Duringthe follow-up, 12 cases （13.6 % ） developed hydronephrosis, 9 cases （ 10.2 % ） renal insufficiency, 12 cases （ 13.6 % ） stricture of the new bladder urethral anastomosis, and 13 cases （14.8 % ） recurrence and metastasis, and 14 patients （15.9 % ） died. However, the cancer related mortality was only 8%. Incontinence occurred in 21 patients （23.9 %）, which was not related to age or gender. Furthermore, there was no statistical difference between those who developed incontinence within one year and after one year. The long-term mortality was not statistically different between those under and over 60 years. The 3-year survival rate was 90.5% （38/42）, and 5-year survival rate was 70% （14/20）. Conclusion The long-term outcome of neobladder after radical cystectomy of bladder cancer is good, the cancer related mortality is low, and renal failure is a major cause of death. The postoperative incontinence is not related to age or gender, the rate of incontinence become stable in one year, and the mortality is not related to age during the follow-up.