两种不同手术方式对肌层浸润性膀胱癌远期生存的疗效观察

Effect of two different surgical methods on long-term survival in muscle invasive bladder cancer

目的探讨两种不同手术方式在肌层浸润性膀胱癌中的应用效果及对患者远期生存的影响。方法选取2012年3月至2019年12月间陕西省咸阳市核工业215医院收治的行膀胱切除术的76例膀胱癌患者。根据患者采用的治疗方法不同进行分组,其中,采用腹腔镜根治性膀胱切除术治疗的38例患者纳入观察组,用开放式根治性膀胱切除术治疗的38例患者纳入对照组。比较两组患者的围术期相关指标、血气分析[pH值、二氧化碳分压(PaCO2)与氧分压(PaO2)]、患者的尿流改道类型、并发症发生率及术后1、3、5年的生存状况,同时比较两组患者术后3个月的生活质量。结果两组患者手术时间、尿流改道类型、尿动力学指标及1年生存率比较,差异无统计学意义(P>0.05)。观察组的术中出血量、需输血人数、住院时间、恢复进食时间及术后肛门排气时间均少于对照组,且PaCO2和PaO2均优于对照组,术后并发症发生率均低于对照组,生活质量评分、3年生存率及5年生存率均高于对照组,差异均有统计学意义(均P<0.05)。结论腹腔镜根治性膀胱切除术具有手术创面小、出血少、远期生存率高等诸多优点,值得在临床上推广。

Objective To investigate the efficacy of two different surgical methods in the treatment of muscle invasive bladder cancer and the effect on long-term survival period.Methods A total of 76 patients with bladder cancer who underwent cystectomy at Shaanxi Nuclear Industry 215 Hospital from March 2012 to December 2019 were selected and divided into an observation group and a control group with 38 patients in each group based on the therapy they received.Laparoscopic radical cystectomy was performed in the observation group and open radical cystectomy was performed in the control group.The perioperative related indices,blood gas analysis(pH value,PaCO2 and PaO2),types of urinary diversion,incidence of complications and postoperative 1-,3-and 5-year survival and 3-month quality of life were compared between the two groups.Results There was no significant difference in the duration of operation,type of urinary diversion,urodynamic indices and 1-year survival rate between the two groups(P>0.05).The intraoperative blood loss,number of patients needing blood transfusion,length of hospital stay,time to eating recovery and time to postoperative anal exhaust were shorter in the observation group than in the control group(all P<0.05).PaCO2 and PaO2 were better in the observation group than in the control group(all P<0.05).The incidence of postoperative complications were significantly lower in the observation group than in the control group(P<0.05).The scores of quality of life,3-and 5-year survival rate were significantly higher in the observation group than in the control group(all P<0.05).Conclusion Laparoscopic radical cystectomy has the advantages of small wound,light bleeding and high long-term survival rate,which is worthy of clini-cal promotion.