经腹膜外改良逆行膀胱全切术＋原位回肠新膀胱术治疗男性浸润性膀胱癌临床观察

Clinical Analysis of Modified Radical Cystectomy Combined with Orthotopic Ileal Neobladder forInvasive Bladder Cancer in Male Patients

【目的】探究经腹膜外改良逆行膀胱全切术＋原位回肠新膀胱术对男性浸润性膀胱癌的临床疗效。【方法】将本院于2016年1月至2017年1月收治的78例浸润性膀胱癌男性患者随机分为观察组和对照，每组各39例，分别采用经腹膜外改良逆行膀胱全切术＋原位回肠新膀胱术及传统膀胱全切术十原位回肠新膀胱术治疗。比较两组术中出血量、手术时间、胃肠功能恢复时间和术后住院时间等指标及两组术后3个月及术后6个月白天、夜间的尿控情况；比较两组术后6个月尿流动力学、并发症发生情况。【结果】观察组的术中出血量、手术时间、胃肠功能恢复时间和术后住院时间等指标明显小于对照组（P〈O．05）；两组术后3个月及术后6个月白天、夜间的尿控情况比较差异无显著性（P〉O．05），但其白天的尿控情况均好于夜间，差异均有统计学意义（P〈0．05）。两组术后6个月的尿动力学指标比较，差异无显著性（P〉0．05）。观察组的并发症总发生率5．13％明显小于对照组的20．51％，差异有统计学意义（P〈O．05）。【结论】经腹膜外改良逆行膀胱全切术＋原位回肠新膀胱术治疗男性浸润性膀胱癌患者，临床疗效显著，能有效改善患者的尿控情况，且术后并发症少，安全可靠，值得临床推广应用。

[Objective]To investigate the clinical efficacy of extraperitoneal modified retrograde cystectomy combined with orthotopic ileal neobladder in the treatment of invasive bladder cancer in men. [Methods]In our hospital, 78 cases of invasive bladder cancer in male patients were randomly divided into observation group （39 ca- ses） and control group （39 cases）. They were treated with extraperitoneal modified retrograde cystectomy com- bined with orthotopic ileal neobladder and conventional cystectomy combined with orthotopic ileal neobladder. The blood loss, operation time, gastrointestinal function recovery time and postoperative hospital stay were compared between the two groups, and the urine control during the day and night 3 months and 6 months after operation in the two groups was also observed. The urine flow dynamics and complications were compared between the two groups at 6 months after operation.[Results]The intraoperative blood loss, operation time, gastrointestinal func- tion recovery time and postoperative hospital stay in the observation group were significantly smaller than those in the control group （ P 〈0.05）day and night urinary continence had no significant difference in the two groups 3 months and 6 months after the operation （ P 〈0.05）. However, the urinary continence during the daytime was better than that in the night, and the difference was statistically significant （ P 〈0.05%There was no significant difference in urodynamic parameters between the two groups at 6 months after operation （ P 〈0.05）.The total in- cidence of complications in the observation group was 5.13%, significantly less than that in the control group 20.51% , and the difference was statistically significant （ P 〈0.05）,[Conclusion]The treatment of male invasive bladder cancer with modified extraperitoneal cysteetomy combined with orthotopic ileal neobladder is of remarkable clinical efficacy, which can effectively improve the patient＇s urine control with less complications. The therapy is safe and reliable and worthy of clinical application.