腹腔镜联合膀胱镜在老年腹膜内型膀胱破裂治疗中的应用

Application of laparoscopy combined with cystoscopy for the treatment of elderly patients with intraperitoneal bladder rupture

目的观察老年腹膜内型膀胱破裂患者采用腹腔镜联合膀胱镜治疗的整体获益,为老年腹膜内型膀胱破裂治疗方案优化提供参考.方法回顾分析,收集我院2017年7月至2020年3月完成腹腔镜修补术治疗的31例老年腹膜内型膀胱破裂患者资料,作为A组;同期医院完成腹腔镜联合膀胱镜修补术治疗的32例老年腹膜内型膀胱破裂患者资料,作为B组;全部患者病历资料、治疗资料、检查资料等均完整.统计并比较两组围术期指标;统计两组术前、随访结束时采用日常生活活动能力评定量表(ADL)评估;统计并比较两组术后并发症发生情况.结果B组手术总耗时[(106.5±10.2)min和(123.3±10.4)min]、总住院时间[(6.2±1.4)d和(8.7±1.6)d]短于A组(t=6.444和6.583,均P<0.001);组间术中出血量[46.4(46.4,47.5)ml和45.7(41.3,47.5)ml,U=1.905,P=0.057]、术后首次排气时间[(2.4±1.1)h和(2.7±1.1)h,t=0.874,P=0.386]、引流管拔除时间[(4.2±0.8)d和(4.3±0.8)d,t=0.619,P=0.539]比较差异无统计学意义;B组术前和随访结束时ADL评分为[52.3(51.9,53.3)分和75.9(75.3,76.4)分;Z=6.832,P<0.01];A组术前和随访结束时ADL评分为[52.2(51.2,53.2)分和65.6(64.6,68.8)分;Z=6.769,P<0.01];两组随访结束时ADL评分均高于术前,且B组高于A组(Z=6.653,P<0.001);B组和A组并发症总发生率比较差异无统计学意义(12.50%和16.12%,x^(2)=0.003,P=0.959).结论老年腹膜内型膀胱破裂患者接受腹腔镜联合膀胱镜治疗,较单用腹腔镜治疗可缩短患者手术时间,促进术后康复,患者治疗后日常生活能力提高,不会增加并发症风险,安全性好.

Objective To examine the overall ben efits of laparoscopy combi ned with cystoscopy for the treatment of elderly patients with intraperitoneal bladder rupture,in order to provide recomme ndations for establish ing the optimal treatment regime n for elderly patients with intraperitoneal bladder rupture.Methods A retrospective analysis was conducted,with clinical data of 31 elderly patients with intraperitoneal bladder rupture(Group A)who received laparoscopic repair at our hospital between July 2017 and March 2020.Group B included 32 elderly patients with intraperitoneal bladder rupture who received repair with laparoscopy combined with cystoscopy during the same period at our hospital.Complete medical records*treatment data and examination data of all patients were available for analysis.Results from perioperative indexes,including activities of daily livingC ADL)scores before the procedure and after the follow-up and postoperative complications,were compared between the two groups.Results Compared with Group A,Group B had a shorter total operation time(106.5±10.2)min vs.(123.3i 10.4)min and a shorter hospitalization time(6.2±1.4)d vs.(&7±1.6)d,wilh statistically significant differences(Z=6.444 and 6.583,P<0.001).The amount of bleeding[46.4(46.4〜47.5)]ml vs.[45.7(41.3〜47.5)mI,U=1.905,P=0.057],time to first passage of flatus](2.4±1.l)h vs.(2.7±1.1)h,Z=0.874,P=0.386]and time to drainage tube removal,(4.2±0.8)d vs.(4.3±0.8)d,t=0.619,P=0.539]showed no statistically significant differences between the two groups.Group B had a preoperative ADL score of 52.3(51.9,53.3)and a post-follow-up score of 75.9(75.3,76.4),while Group A had a pre-operative score of 52.2(51.2,53.2)and a post-follow-up score of 65.6(64.6,68.8).At the end of the follow-up,ADL scores of both groups were higher than those before the procedure(Group E:Z=6.832,Group A:Z=6.769,P < 0.01),but ADL scores in Group B were higher than in Group A,with statistical significance(Z=6.653,P<0.001);The two groups had no statistical difference in total incidence of complications(12.50%vs.16.12%,X^(2)=0.003,P=0.959).Conclusions Compared with laparoscopy alone,laparoscopy combined with cystoscopy can shorten the operation time and promote postoperative rehabilitation for the treatment of elderly patients with intraperitoneal bladder rupture and improve activities of daily living of patients»without increasing the risk of complications,indicating good safety.