根治性膀胱全切联合体外Studer原位新膀胱术47例临床病理特征及预后分析

Analysis of perioperative clinicopathologic characteristics and prognosis of 47 patients who received radical cystectomy combined with extracorporeal Studer ileal neobladder

目的比较开放、腹腔镜及机器人辅助下根治性膀胱全切联合体外Studer原位新膀胱患者的围手术期临床病理特征及肿瘤控制效果。方法回顾性分析我院从2004年1月至2018年12月行根治性膀胱全切联合体外Studer原位新膀胱术的47例资料完整的患者临床病理信息,其中开放组33例,腹腔镜及机器人组各7例,对3组患者的围手术期情况及肿瘤控制效果进行对比分析。结果腹腔镜及机器人组手术均顺利完成,术中均未发生严重并发症。机器人组较开放及腹腔镜组手术时间稍长[(552.86±145.80)min vs.(474.55±90.22)min vs.(468.43±39.88)min;P>0.05],术中平均出血量减少[(235.71±102.93)mL vs.(1090±629.37)mL vs.(457.14±171.82)mL;P=0.001、P=0.02]。机器人组患者术后平均进食及住院时间较开放组显著缩短[(4.57±1.62)d vs.(7.55±4.99)d,P=0.03;(13.29±4.62)d vs.(33.48±26.92)d,P=0.002],与腹腔镜组相比均无差异(P均>0.05)。所有患者手术切缘均为阴性,3组患者术后1年内复发及死亡率无明显差异(P均>0.05)。结论机器人辅助下根治性膀胱全切联合体外Studer原位新膀胱安全可行,相较于开放及腹腔镜,机器人辅助下腹腔镜具有术中失血少、术后康复速度快等优势,且肿瘤治疗效果与开放及腹腔镜相似。

Objective To compare the perioperative clinicopathologic characteristics and prognosis among open radical cystectomy(ORC),laparoscopic radical cystectomy(LRC)and robot-assisted radical cystectomy(RARC)combined with extracorporeal Studer ileal neobladder.Methods The data of 47 patients who received radical cystectomy combined with extracorporeal Studer ileal neobladder during Jan.2004 and Dec.2018 were retrospectively collected,including 33 cases with ORC,7 cases with LRC and 7 cases with RARC.Comparative analysis of perioperative clinicopathologic characteristic and tumor control among ORC,LRC and RARC was performed.Results All operations were successful and no serious complications occurred.The operation time of RARC was longer than ORC and LRC:(552.86±145.80)min vs.(474.55±90.22)min vs.(468.43±39.88)min,P>0.05.The mean intraoperative blood loss was less when compared with ORC and LRC:(235.71±102.93)mL vs.(1090±629.37)mL vs.(457.14±171.82)mL,P=0.001,P=0.02.The length of oral intake and hospital stay after operation in RARC group were shorter when compared with the ORC group:(4.57±1.62)d vs.(7.55±4.99)d,P=0.03,(13.29±4.62)d vs.(33.48±26.92)d,P=0.002,but the difference was not significant between RARC and LRC groups.Moreover,all surgical margins were negative and there were no differences in 1-year recurrence and mortality rates among ORC,LRC and RARC groups(P>0.05).Conclusion RARC combined with extracorporeal Studer ileal neobladder is safe and feasible,with advantages of less intraoperative blood loss and faster postoperative recovery when compared with ORC and LRC.What s more,the short-term effect of tumor control is similar among ORC,LRC and RARC.