腹腔镜下膀胱根治性切除联合原位U形与W形回肠新膀胱术治疗膀胱癌的临床疗效比较

Comparison of clinical efficacy of laparoscopic radical cystectomy combined with orthotopic U-shaped and W-shaped ileal neobladder surgery in the treatment of bladder cancer

目的比较腹腔镜下膀胱根治性切除联合原位U形与W形回肠新膀胱术治疗膀胱癌的临床疗效。方法回顾性分析行腹腔镜下膀胱根治性切除联合原位回肠新膀胱术的68例患者的临床资料,根据回肠新膀胱的构建方式将其分为2组,U组28例患者构建U形新膀胱,W组40例患者构建W形新膀胱。比较2组患者围术期相关指标、术后随访情况及术后并发症情况。结果U组患者手术时间及术后排气时间短于W组(P<0.05);2组患者术中出血量及术后住院时间比较,差异无统计学意义(P>0.05)。U组患者新膀胱容量小于W组(P<0.05);2组患者最大尿流率及残余尿量比较,差异无统计学意义(P>0.05)。2组患者夜间尿控满意率均低于日间尿控满意率(P<0.05)。2组患者术后并发症总发生率比较,差异无统计学意义(P>0.05);U组患者术后尿失禁发生率高于W组(P<0.05),其余术后并发症发生率2组比较差异无统计学意义(P>0.05)。结论与U形膀胱相比,W形膀胱具有更大的膀胱容量和更低的尿失禁发生率,但W形膀胱手术时间及术后排气时间较长,患者术后胃肠道功能恢复较慢。

Objective To compare the clinical efficacy of laparoscopic radical cystectomy combined with orthotopic U-shaped and W-shaped ileal neobladder surgery in the treatment of bladder cancer.Methods The clinical data of 68 patients who underwent laparoscopic radical cystectomy combined with orthotopic ileal neobladder surgery were retrospectively analyzed.According to the construction method of the ileal neobladder,these patients were divided into two groups,28 patients in the U group constructed U-shaped neobladder,and 40 patients in the W group constructed W-shaped neobladder.The perioperative related indicators,postoperative follow-up and postoperative complications of the two groups were compared.Results The operation time and postoperative exhaust time of the U group were shorter than those of the W group(P<0.05).There was no statistically significant difference in the amount of intraoperative blood loss and postoperative hospital stay between the two groups(P>0.05).The volume of the neobladder in the U group was smaller than that in the W group(P<0.05).There was no statistically significant difference in the maximum urine flow rate and residual urine volume between the two groups(P>0.05).The satisfaction rate of night urinary control was lower than that of daytime urinary control in both of the two groups(P<0.05).There was no statistically significant difference in the total incidence of postoperative complications between the two groups(P>0.05).The incidence of postoperative urinary incontinence in the U group was higher than that in the W group(P<0.05),and there was no statistically significant difference in the incidence of other postoperative complications between the two groups(P>0.05).Conclusion Compared with the U-shaped neobladder,the W-shaped neobladder has a larger bladder volume and a lower incidence of urinary incontinence.However,the operation time and postoperative exhaust time of the W-shaped neobladder are longer,and the recovery of patient’s postoperative bowel function is slower.