机器人辅助下根治性膀胱切除全腹腔内与腹腔外回肠通道术后早期并发症研究

Study of early postoperative complications between intracorporeal and extracorporeal ileal conduit after robot-assisted radical cystectomy

目的:比较机器人辅助下根治性膀胱切除术(RARC)后全腹腔内回肠通道术(ICIC)与腹腔外回肠通道术(ECIC)的术后早期并发症。方法:回顾性分析我院2016年10月-2022年4月围手术期接受加速康复方案的机器人辅助下RARC+回肠通道术的54例膀胱癌患者资料,其中ICIC组21例,ECIC组33例,对两组患者的基本资料、围手术期数据及术后早期并发症进行分析对比。结果:ICIC组与ECIC组性别(P<0.001)及手术时间(335 min vs.400 min,P=0.028)差异有统计学意义,在BMI、随访时间、美国麻醉师协会(ASA)评分、肿瘤病理T分期、N分期、住院天数、术中失血量、淋巴结清扫个数及术后早期并发症等方面差异无统计学意义。术后早期并发症发生率ICIC组为23.8%(5/21),ECIC组为45.5%(15/33)。术后不全性肠梗阻置入胃管发生率ICIC组为9.5%(2/21),ECIC组为21.2%(7/33)。结论:ICIC在降低肠道相关并发症方面可能存在潜在的临床意义,仍需积累样本量和进一步随访来验证。

Objective:To compare early postoperative complications between intracorporeal ileal conduit(ICIC)and extracorporeal ileal conduit(ECIC)after the treatment of robot-assisted radical cystectomy(RARC).Methods:The data of 54 patients with bladder cancer who received RARC+ileal tunnel surgery and enhanced recovery after surgery in our hospital from October 2016 to April 2022 were retrospectively analyzed,including 21 cases in ICIC group and 33 cases in ECIC group.The basic data,perioperative data,and early postoperative complications of the patients were analyzed and compared.Results:There were significant differences in gender(P<0.001)and operation time(335 min vs.400 min,P=0.028)between ICIC group and ECIC group,while there was no difference in BMI,follow-up time,ASA score,tumor pathological T stage,N stage,hospital stay,intraoperative blood loss,number of lymph node dissections,or early postoperative complication.The incidence of early postoperative complications was 23.8%(5/21)in ICIC group and 45.5%(15/33)in ECIC group.The incidence of postoperative incomplete intestinal obstruction with gastric tube placement was 9.5%(2/21)in ICIC group and 21.2%(7/33)in ECIC group.Conclusion:ICIC may have potential clinical significance to reduce intestinal-related complications,which still needs to be verified by accumulating sample size and further follow-up.