根治性膀胱切除患者双侧输尿管单侧皮肤造口术的长期疗效分析

A long-term clinical report of a modified unilateral cutaneous ureterostomy in bladder cancer patients receiving radical cystectomy

目的探讨根治性膀胱切除患者行双侧输尿管单侧皮肤造口术的长期疗效。方法回顾性分析2013年1月至2020年12月于上海市第十人民医院行输尿管皮肤造口术的104例膀胱癌患者的临床资料,其中66例根治术后行双侧输尿管单侧皮肤造口术(单侧组),38例行双侧输尿管双侧皮肤造口术(双侧组)。单侧组男53例,女13例;年龄(71.8±9.8)岁;体质指数(23.3±3.2)kg/m^(2)。双侧组男33例,女5例;年龄(75.1±10.8)岁;体质指数(22.7±3.0)kg/m^(2);两组差异均无统计学意义(P>0.05)。比较两组患者病理、生存状况、远期并发症。随访过程中患者填写欧洲癌症患者生活质量核心问卷(EORTC QLQ-C30),评估患者术前和术后生活质量,比较两组患者生活质量的差异。结果单侧组肌层浸润性膀胱癌(MIBC)46例(69.7%),淋巴结转移15例(22.7%),远处转移7例(10.6%);双侧组MIBC 24例(63.2%),淋巴结转移6例(15.8%),远处转移2例(5.3%);两组差异均无统计学意义(P>0.05)。单侧组中位随访时间31.6(3.7~84.8)个月,31例死亡,其中28例死于肿瘤进展;双侧组中位随访时间28.2(4.1~131.2)个月,23例死亡,其中16例死于肿瘤进展,两组疾病特异性死亡率差异无统计学意义(P>0.05)。随访期间单侧组总体并发症发生率显著低于双侧组[43.9%(29/66)与63.2%(24/38),P<0.001],其中单侧组肾盂肾炎发生率显著低于双侧组[16.6%(11/66)与42.1%(16/38),P=0.006]。单侧组与双侧组术前生活质量评分差异均无统计学意义;术后单侧组躯体功能评分[(54.9±7.1)分]和情感功能评分[(63.1±6.4)分]均高于双侧组[(49.2±6.7)分和(59.9±6.7)分,P<0.05]。结论根治性膀胱切除患者采用双侧输尿管单侧皮肤造口的方式并发症发生率较低,一定程度上可提高患者生活质量。

Objective To explore the long-term efficacy of a modified unilateral cutaneous ureterostomy in bladder cancer patients receiving radical cystectomy.Methods The medical data of 104 bladder cancer patients who underwent ureterostomy in our hospital from Janurary 2013 to December 2020 were retrospectively analyzed.The patients were divided into unilateral and bilateral group.The unilateral group contained 66 cases,with 53 males and 13 females,average age(71.8±9.8)years,body mass index(BMI)(23.3±3.2)kg/m^(2).The bilateral group contained 38 cases,with 33 males and 5 females,average age(75.1±10.8)years;BMI(22.7±3.0)kg/m^(2).There was no significant difference in the above characteristics between the two groups(P>0.05).The pathology,survival status,long-term complications between the two groups were compared.Quality of life was assessed during follow-up using the European Core Questionnaire for Quality of Life in Cancer Patients(EORTC QLQ-C30).Results The unilateral group contained 46(69.7%)muscle invasive bladder cancer(MIBC)cases,15(22.7%)cases with lymph node metastasis,7(10.6%)cases with distant metastasis.The bilateral group contained 24(63.2%)muscle invasive bladder cancer(MIBC)cases,6(15.8%)cases with lymph node metastasis,2(5.3%)cases with distant metastasis.There was no significant difference in disease specific survival between the two groups(P>0.05).During the follow-up,the incidence of overall complication rate in the unilateral group was significantly lower than that in the bilateral group[43.9%(29/66)vs.63.2%(24/38),P<0.001].The incidence of pyelonephritis in unilateral group was significantly lower than that in the bilateral group[16.6%(11/66)vs.42.1%(16/38),P=0.006].There was no statistical significance in terms of quality of life before operation in the two groups.After operation,both physical function score[(54.9±7.1)vs.(49.2±6.7)]and emotional function score[(63.1±6.4)vs.(59.9±6.7)]in unilateral group were higher than that in bilateral group(P<0.05).Conclusions The modified unilateral cutaneous ureterostomy could achieve relatively low complication rate,and improve the quality of life to some extent compared with bilateral ureterostomy.