淋巴结清除范围与腹腔镜根治性膀胱切除术后并发症和再入院的相关性研究

Study on the Correlation between Complications and Readmission after Laparoscopic Radical Cystectomy and Lymph Node Dissection Scope

目的探讨腹腔镜根治性膀胱切除术中采用扩大淋巴结清扫(extended pelvic lymph node dissection,ePLND)与标准淋巴结清扫(standard pelvic lymph node dissection,sPLND)对膀胱癌患者术后并发症、再入院及预后的影响.方法对2012年1月~2017年4月因膀胱癌在新疆医科大学第一附属医院行腹腔镜根治性膀胱切除术的患者160例进行回顾性分析,根据术中淋巴结清扫情况划分为ePLND组(73例)和sPLND组(87例);记录两组患者围术期并发症发生率、出院后90天内再入院率,采用COX回归模型分析影响患者再入院的危险因素;比较两组患者无进展生存期(progression free survival,PFS)、总生存期(overall survival,OS)的差异.结果术后并发症发生率ePLND组为28.77%(21/73),sPLND组为22.99%(20/87),两组比较差异无统计学意义(x2=0.695,P=0.404);出院后90天内两组患者共有19例再入院手术,其中ePLND组8例,sPLND组11例,两组比较差异无统计学意义(x2=0.107,P=0.743);COX回归分析显示,低蛋白血症(HR=15.098)、肠瘘(HR=11.068)、切口脂肪液化(HR=12.710)是导致患者再人院的独立危险因素(P均<0.05);两组患者均未达到中位PFS和OS,其中ePLND组2年PFS率为80.00%(56/70),sPLND组为64.63%(53/82),两组比较差异有统计学意义(Log-Rank x2=5.201,P=0.023);ePLND组2年OS率为87.14%(61/70),sPLND组为78.05%(64/82),两组比较差异无统计学意义(Log-Rank x2=2.624,P=0.105).结论腹腔镜根治性膀胱切除术中采用扩大淋巴结清扫并不会增加术后并发症发生率,但能够提高患者无进展生存率.预防术后低蛋白血症、肠瘘、切口脂肪液化对于减少患者再入院手术具有积极意义.

Objective To investigate the effect of extended pelvic lymph node dissection(ePLND) and standard pelvic lymph node dissection(sPLND) on the complications, readmission and prognosis of patients with bladder cancer after laparoscopic radical cystectomy. Methods From January 2012 to April 2017, 160 patients with bladder cancer underwent laparoscopic radical cystectomy in the First Affiliated Hospital of Xinjiang Medical University were analyzed retrospectively. Lymph node dissection was divided into ePLND group(73 cases) and sPLND group(87 cases). The incidence of perioperative complications and readmission rate within 90 days after discharge were recorded. COX regression model was used to analyze the risk factors affecting readmission. Progressive free survival(PFS) and Overall survival(OS) were compared between the two groups. Results The incidence of postoperative complications was 28.77%(21/73) in ePLND group and 22.99%(20/87) in sPLND group, with no significant difference(χ~2=0.695, P=0.404). Within 90 days after discharge, there were 19 re-admission operations in the two groups, 8 in the ePLND group and 11 in the sPLND group, with no significant difference(χ~2=0.107, P=0.743). COX regression analysis showed that hypoproteinemia(HR=15.098), intestinal fistula(HR=11.068), incision fat liquefaction(HR=12.710) were independent risk factors for readmission(all P<0.05). The two groups did not reach the median PFS and OS. The two-year PFS rate in ePLND group was 80.00%(56/70) and that in sPLND group was 64.63%(53/82), with significant difference(Log-Rank χ~2=5.201, P=0.023). OS in ePLND group was 87.14%(61/70) in 2 years and 78.05%(64/82) in sPLND group. There was no significant difference(Log-Rank χ~2=2.624, P=0.105). Conclusion Extended lymph node dissection in laparoscopic radical cystectomy does not increase the incidence of complications, but can improve the progression-free survival rate of patients. Preventing hypoproteinemia, intestinal fistula and incision fat liquefaction after operation has positive significance for reducing patient′s re-admission operation.