腹腔镜膀胱全切术后回肠流出道术与输尿管皮肤造口术后并发症及生活质量比较

Comparison of the complications and quality of life between ileal conduit and cutaneous ureterostomy after laparoscopic radical cystectomy

目的:比较腹腔镜膀胱全切术后与不可控尿流改道术,即回肠流出道术(IC)及输尿管皮肤造口术(CU)相关的术后并发症发生情况及生活质量。方法:回顾性纳入2020年11月—2022年3月于四川大学华西医院接受腹腔镜膀胱全切术和后续不可控尿流改道术的77例患者,其中IC组56例,CU组21例。随访术后早期及晚期并发症的发生情况及生存质量状况,通过t检验、Mann-Whitney U检验和χ^(2)检验及其校正公式来比较两组间的差异。通过EQ-5D-3L问卷评估患者术后生活质量。结果:腹腔镜膀胱全切术后接受不可控尿流改道术的患者中,CU组伴肾功能不全(28.6%vs.5.4%)和尿路感染(28.6%vs.5.4%)的患者比例均显著高于IC组(均P<0.05)。IC组和CU组术后早期并发症发生率均为28.6%,术后晚期并发症发生率分别为19.6%与23.8%,两组术后早、晚期并发症发生率均差异无统计学意义。两组术后生活质量差异无统计学意义。结论:在腹腔镜膀胱全切术后,CU更倾向于被应用在身体状况较差的患者群体,其围术期、术后并发症及生活质量方面与IC比较没有显著劣势,因此CU仍可作为一种可推荐的不可控尿流改道术式。

Objective:To compare the postoperative complications and quality of life associated with urinary diversion between cutaneous ureterostomy(CU)and ileal conduit(IC)after laparoscopic radical cystectomy.Methods:This retrospective study included 77 patients with bladder cancer who underwent laparoscopic radical cystectomy and subsequent CU(n=21)and IC(n=56)at West China Hospital,Sichuan University from November 2020 to March 2022.The incidence of early and late postoperative complications and quality of life were followed up,and the differences between the two groups were compared using t-test,Mann-Whitney U test,Chi-Square test and the correction formula.The EQ-5 D-3 L questionnaire was used to assess the patients’postoperative quality of life.Results:Among patients with bladder cancer who underwent laparoscopic radical cystectomy and subsequent urinary diversion,the proportions of patients with renal dysfunction(28.6%vs.5.4%)and urinary tract infection(28.6%vs.5.4%)in the CU group were significantly higher than those in the IC group(both P<0.05).The incidence of early postoperative complications in the IC group and CU group were 28.6%,respectively,and the late complications rate were 19.6%in the IC group and 23.8%in the CU group.There were no significant differences in the incidence of early and late postoperative complications or quality of life between the two groups.Conclusion:After laparoscopic radical cystectomy,CU tends to be operated in patients with poor physical condition,and its perioperative,postoperative complications and quality of life are not significantly inferior to IC.Thus CU can still be used as a recommended uncontrolled urinary flow diversion.