腹腔镜与开放根治性膀胱全切-回肠膀胱术疗效比较

Comparison of laparoscopic and open surgery for radical cystectomy with ileal conduit surgery

目的比较腹腔镜与开放根治性膀胱全切-回肠膀胱术的临床疗效。方法回顾性分析我院自2011年6月至2016年1月行开放（ORC）及腹腔镜（LRC）根治性膀胱全切-回肠膀胱术62例患者的资料,其中ORC组32例,LRC组30例。对两组患者的术前基本资料、围术期数据、术后并发症情况进行对比分析。结果 LRC组较ORC组具有术中出血量少（P=0.000）,住院时间短（P=0.000）的特点。所有患者术后切缘均为阴性,两组患者在淋巴结清扫个数（P=0.085）以及淋巴结阳性率（P=0.922）方面无统计学差异。两组患者在肿瘤病理分期（P=0.999）,分级（P=0.878）方面无统计学差异。中位随访时间36.5个月（6~56个月）,ORC组较LRC组具有术后肠梗阻发生率低（P=0.040）的特点。结论与开放手术相比,腹腔镜根治性膀胱全切-回肠膀胱术具有术中出血少、术后恢复快的特点,其术后病理学结果与开放手术疗效相当,但其术后肠梗阻发生率明显高于开放手术。考虑腹腔镜术后无法保留腹膜完整性为主要原因。

Objective To compare the clinical efficacy of laparoscopic radical cystectomy（LRC）and open radical cystectomy（ORC）for the treatment of ileal conduit surgery.Methods Sixty-two patients with LRC and ORC for the treatment of ileal conduit surgery from 2011 January to 2016 June were retrospectively reviewed.A total of 30 patients received LRC and ileal conduit surgery,and 32 cases of ORC were enrolled for comparison.The demographic parameters of patients,perioperative data,postoperative complication and oncology results were recorded and evaluated.Results The LRC group had less extimated blood loss（P=0.000）,shorter hospital stay（P=0.000）compared with the ORC group.There was no difference in the mean number of dissected lymph nodes（P=0.085）,and lymph node positive rate（P=0.922）between the two groups.There was no difference in term of tumor pathological staging classification.The median follow-up was 36.5months（6~56months）.The ORC group had lower incidence of intestinal obstruction（P=0.040）.Conclusion Compared with ORC,LRC has advantages of less blood loss,shorter hospital stay in the treatment of ileal conduit surgery.It produces comparable tumor control as ORC.It had higher incidence of intestinal obstruction.We believed that in the process of the laparoscopic surgery the cause is that we can＇t keep peritoneal integrity.