既往手术史对开放和腹腔镜根治性膀胱切除术影响的对照研究

Laparoscopic versus open radical cystectomy for patients with previous abdominal surgery:comparison of perioperative and oncologic outcomes

目的评价有盆腹腔手术史的患者行开放和腹腔镜根治性膀胱切除术的可行性和安全性。方法行根治性膀胱切除术并且具有盆腹腔手术史的患者81例。比较开放和腹腔镜根治性膀胱切除术患者的手术时间、术中预计出血量、术中输血例数、留置引流管时间、临床病理分期、术中清除淋巴结个数、切缘阳性例数、肠道功能恢复时间、术后住院时间以及术后90天内并发症的发生率。结果两组患者性别、年龄、体重指数、ASA评分比较,差异无统计学意义。腹腔镜手术组的平均手术时间长于开放手术组(P<0.05),术中失血量和术中需要输血例数低于开放手术组(P<0.01)。开放手术组术中血管损伤率高于腹腔镜手术组(P<0.01)。两组患者术后切缘阳性例数比较差异无统计学意义(P>0.05),但腹腔镜手术组患者术中清除的淋巴结个数多于开放手术(P<0.01)。两组患者在术后并发症发生率比较,差异无统计学意义(P>0.05)。结论对于有手术史的根治性膀胱切除术患者,与开放根治性膀胱切除术比较,腹腔镜手术具有更高的可行性及安全性。

Objective To investigate and compare the feasibility and safety of laparoscopic radical cystectomy（LRC）and open radical cystectomy（ORC）in patients with previous abdominal surgery（PAS）.Methods Eight-one patients with PAS undergoing ORC or LRC with bilateral pelvic lymph node dissection（PLND）and ileal conduit（IC）at a single center were retrospectively reviewed.Demographic parameters,intra-operative variables,peri-operative records,pathologic outcomes and complication rate were retrieved to assess the impact of PAS on feasibility and outcomes.Results Patients in both ORC and LRC subgroups were homogeneous in terms of gender,age,BMI and ASA score.Operating time is longer in LRC groups（P=0.011）,while estimated blood loss（EBL）,and transfusion rate were higher in patients with PAS undergoing ORC compared with LRC（P=0.001）.There was no statistical difference in peri-operative parameters outcomes.Patients with PAS undergoing ORC had a higher vascular injury rate compared with LRC（P=0.001）.No statistical difference had been found in positive surgical margin（P=0.395）,while LRC retrieved more lymph nodes than ORC（P=0.001）.There is no significant difference in post-complication between two groups（P=0.725）.Conclusion Patients with PAS may benefit from LRC with lower estimated blood loss,fewer transfusion rates and vascular injuries,and great lymph nodes retrieved.