不同尿流改道术式对膀胱癌全膀胱切除术相关指标、术后并发症及预后的影响

The effects of different urinary diversion methods on surgery-related indexes,postoperative complications and prognosis of patients with bladder cancer undergoing radical cystectomy

目的探讨全膀胱切除术不同尿流改道术式对膀胱癌患者手术相关指标、术后并发症及预后的影响。方法选取行全膀胱切除尿流改道术治疗的膀胱癌患者87例,根据尿流改道术式的不同分为A组(回肠代膀胱尿流改道术式,n=38)、B组(原位新膀胱尿流改道术式,n=26)和C组(输尿管皮层造口尿流改道术式,n=23),比较三组手术相关指标、术后并发症及预后情况。结果C组手术时间、肠道恢复时间和术后住院时间均短于A、B组,术中出血量小于A、B组(P<0.05);A、B组手术相关指标比较差异无统计学意义(P>0.05)。术后3个月,三组并发症发生率比较差异无统计学意义(P>0.05);三组躯体状况、功能状况、情感状况及癌症患者生命质量共性量表(FACT-G)总分比较,差异有统计学意义(P<0.05),社会家庭状况评分差异无统计学意义(P>0.05);B组躯体状况、功能状况、情感状况及FACT-G总分高于A、C组(P<0.05),A、C组FACT-G总分及各项目评分比较,差异无统计学意义(P>0.05);三组亚利桑那性体验表(ASEX)评分均较术前升高(P<0.05),但三组间比较差异无统计学意义(P>0.05)。结论三种尿流改道术是治疗膀胱癌的主要手术方式,患者术后并发症发生率无明显统计学差异,与其他两种尿流改道术式比较,原位新膀胱尿流改道术在改善患者生活质量方面效果更佳。

Objective To explore the effects of different urinary diversion methods on surgery-relatedindexes,postoperative complications and prognosis of patients with bladder cancer undergoing radical cystectomy.Methods A total of 87 radical cystectomy patients with bladder cancer who underwent urinary diversion in our hospital were enrolled and divided into group A(ileal neobladder urinary diversion,n=38),group B(orthotopic neobladder urinary diversion,n=26)and group C(ureterostomy urinary diversion,n=23)according to different urinary diversion methods.The surgery-relatedindexes,postoperative complications and prognosis were compared among the three groups.Results The operation time,intestinal recovery time and postoperative hospitalization time were shorter and intraoperative blood loss was less in the group C than that in the groups A and B(P<0.05).There was no significant difference in surgery-relatedindexes between groups A and B(P>0.05).After 3 months of surgery,there was no significant difference in postoperative complications among the three groups(P>0.05).After surgery,there were significant differences in scores of physical status,functional status and emotional status and total score of functional assessment of cancer therapy-general(FACT-G)among the three groups(P<0.05),but there was no significant difference in score of social and family status among the three groups(P>0.05).The scores of physical status,functional status and emotional status,and total score of FACT-G in the group B were higher than those in groups A and C(P<0.05).There was no significant difference in total score of FACT-G,and scores of all items between groups A and C(P>0.05).After surgery,the score of Arizona Sexual Experience Scale(ASEX)was increased when compared to before surgery in the three groups(P<0.05).However,there was no significant difference in the score among the three groups(P>0.05).Conclusion The three urinary diversion methods are main surgical methods for bladder cancer,and there is no statistical difference in the incidence of postoperative complications.Compared with the other urinary diversion methods,orthotopic neobladder urinary diversion is more effective in improving the quality of life.