腹腔镜与开放膀胱根治性切除原位膀胱术并发症和肿瘤控制比较

Comparison of complications and oncologic outcomes between laparoscopic and open cystectomy with orthotopic ileal neobladder

目的：比较278例腹腔镜根治性膀胱切除原位膀胱术及176例开放手术患者手术并发症及肿瘤学结果。方法：回顾分析我院2007～2014年间行腹腔镜根治性膀胱切除原位膀胱术患者及开放手术患者,对主要围手术期相关、术后早期（〈90d）并发症、晚期（〉90d）并发症、术后肿瘤控制结局进行比较。结果：术中出血量及输血率、术后留置盆腔引流管时间、术后住院时间等方面腹腔镜根治性膀胱切除术组与开放手术相比较有明显的优势,术后胃肠通气时间两者没有明显差异,而平均手术时间开放手术组短于腹腔镜手术组;两组术后早期（〈90d）并发症发生率的差异有统计学意义（腹腔镜组46.0%,开放组61.4%,P〈0.01）,晚期（〉90d）并发症发生率差异无统计学意义（腹腔镜组15.1%,开放组17.6%,P=0.513）;术后36个月复发率（腹腔镜组7.6%,开放组8.5%,P=0.724）,总体生存率（腹腔镜组80.6%,开放组83.5%,P=0.457）的差异无统计学意义。结论：腹腔镜膀胱根治性切除原位膀胱术与开放手术相比,早期并发症的发生率稍低,而晚期并发症及术后肿瘤控制情况无明显差异。

Objective：To compare the complications and oncologic outcomes between 278 cases with laparoscopic assisted radical cystectomy（LRC）and 176 cases with open radical cystectomy（ORC）followed by orthotopic ileal neobladder.Method：From 2007 to 2014,278 patients with bladder cancer in our hospital treated by LRC and 176 patients treated by ORC with orthotopic ileal neobladder were enrolled in our current study.Early and late complications,recurrence rate and survival rate were recorded and analyzed.Result：Length of stay after surgery and time of indwelling drainage were significantly shorter,and blood loss and transfusion rates were obviously lower in LRC group.However,mean operative time was longer in LRC group than that in ORC group.The time to flatus was of no significant difference between the two groups.Overall,the early complication rates were46.0% and 61.4%（P 〈0.01）in LRC and ORC group,and the late complication rates were 15.1% and 17.6%（P =0.513）,respectively.After 36-month follow-up,the recurrence rates were 7.6%and 8.5%（P =0.724）and overall survival rates were 80.6% and 83.5 %（P =0.457）in LRC and ORC group,respectively.Conclusion：Compared with ORC,LRC has lower rates of early complications,while the late complications and oncologic results are of no statistical difference.