腹腔镜全膀胱切除回肠代膀胱腹壁造口术后并发症Clavien分类及患者长期生活质量的探讨

The Clavien complications and long-term quality of life of patients with invasive bladder cancer after laparoscopic radical cystectomy and ileal conduit

目的:探讨腹腔镜全膀胱切除回肠代膀胱腹壁造口术后Clavien并发症分类情况,并评估患者长期生活质量。方法:回顾分析2008年6月至2012年6月为32例患者行腹腔镜全膀胱切除回肠代膀胱腹壁造口术的临床资料,采用Clavien并发症分级系统对患者术后并发症进行分级,采用QLQ-C30问卷对患者术后生活质量进行评估。结果:术后16例患者发生并发症,包括发热、感染、肠梗阻、肾盂肾炎、输尿管与代膀胱吻合口狭窄等。患者术后相关生活质量功能评分术后6个月较术前降低,术后6个月后逐渐提高。术后整体健康情况、症状相关生活质量较术前提高。经济问题在术后越来越影响患者的生活质量。结论:腹腔镜全膀胱切除回肠代膀胱腹壁造口术可较安全、有效地治疗浸润性膀胱癌,患者术后生活质量随其对腹壁造口新生活的逐步适应而不断改善,因此在目前条件下,此手术是较为合适的尿流改道方案。

Objective： To explore the Clavien complications and long-term quality of life（ Qo L） of patients with invasive bladder cancer（ BC） after laparoscopic radical cystectomy（ LRC） and ileal conduit（ IC）. Methods： A retrospective analysis of patients with invasive BC undergoing LRC and IC was carried out from Jun. 2008 to Jun. 2012. The Clavien classification system was carried out to stratify postoperative complications. QLQ-C30 questionnaire was applied to evaluate the Qo L of patients after LRC and IC. Results：Postoperative complication occurred in 16 patients,including pyrexia,infection,ileus,pyelonephritis and uretero-pouch / conduit anastomotic stricture. The function scale of Qo L after surgery declined comparing with that of pre-operation at 6-month follow up,however the scales during subsequent following up gradually improved. With respect to the global health status and symptom scale of Qo L undergoing LRC and IC,the scales gradually improved after operation. However the financial difficulty of patient was increasingly becoming an obstacle over time. Conclusions： LRC and IC is a safe and effective treatment for invasive BC. The Qo L of patients is closely associated with their adaptation to new life with a stoma after the operation,which is an appropriate solution in current situation.