根治性膀胱切除术后回肠与乙状结肠2种原位新膀胱术的临床疗效观察

Comparison of the efficacy between orthotopic ileum and sigmoid colon neobladder after radical cystectomy

目的:探究根治性膀胱切除术后回肠与乙状结肠2种原位新膀胱术的临床疗效及术后并发症发生率的差异。方法:选取2010年4月~2015年2月我院收治的膀胱癌患者86例作为研究对象。所有患者均行根治性膀胱切除术+原位新膀胱术,按手术方式不同,接受回肠原位新膀胱术的51例患者分为A组,接受乙状结肠原位新膀胱术的35例患者为B组。记录两组患者的手术时间、术中出血量以及术后住院时间。所有患者术后定期随访,均随访满18个月,观察记录两组患者术后并发症发生情况、术后3周控尿能力及术后6个月的尿流动力学检查结果。结果:A组患者手术时间、术中出血量以及术后住院时间均明显多于B组患者,差异有统计学意义(P<0.05);两组患者术后总并发症发生率差异无统计学意义,术后并发症Clavien-Dindo分级比较差异无统计学意义;A组患者术后3周夜间可控尿率明显高于B组,差异有统计学意义(P<0.05);两组患者术后6个月的膀胱剩余尿和最大尿流率差异无统计学意义;A组术后6个月的膀胱最大储尿量明显高于B组,而膀胱充盈压和排尿压均明显低于B组,差异有统计学意义(P<0.05);两组患者术后18个月肿瘤复发率及生活质量评分比较差异无统计学意义。结论:相比回肠原位新膀胱术,乙状结肠原位新膀胱术具有手术操作较简单、术中出血量少、术后恢复快等优势,而回肠原位新膀胱术术后夜间控尿率较满意,膀胱储尿量大,顺应性好。2种原位新膀胱术均能取得满意疗效,术后并发症发生率及Clavien-Dindo分级差异无统计学意义,随访18个月肿瘤复发率及生活质量评分差异无统计学意义,临床上可根据患者个体情况和医生擅长术式决定治疗方案。

Objective：To compare the efficacy between orthotopic ileum and sigmoid colon neobladder after radical cystectomy.Method：We selected 86 patients with bladder cancer in our hospital from April 2010 to February 2015 as the research objects.All patients were divided into two groups according to the different operations they underwent.Fifty-one patients in A group received orthotopic ileum neobladder,while 35 patients in B group received orthotopic sigmoid colon neobladder.We detected and compared the results of urodynamic examination,continence and the occurrence of adverse reactions after operation.Result：The operation time,blood loss and hospital stay of A group were significantly more than those of B group,and the difference was statistically significant.The difference of complication rate and Clavien-Dindo classification between A and B group was not statistically significant.The continence rate at night three weeks after operation of A group was obviously higher than that of B group,and the difference was statistically significant.The compliance and urine storage capacity six months after operation of A group was obviously superior to those of B group,and the difference was statistically significant.The difference of tumor recurrence rate between A and B group was not statistically significant.The difference of quality of life between A and B group was not statistically significant.Conclusion：Compared with orthotopic ileum neobladder,orthotopic sigmoid colon neobladder has the advantages of shorter operation time,less bleeding and faster recovery.But orthotopic ileum neobladder has the advantages of better continence rate at night,better compliance and greater urine storage capacity.The difference of complication rate between A and B group was not statistically significant.The methods of operation should be decided according to patient＇s situation and the operation surgeon＇s experience.