腹腔镜全膀胱切除术后输尿管皮肤造口与原位新膀胱两种术式临床疗效分析

Clinical analysis of urinary diversion and orthotopic ileal bladder after laparoscopic radical cystectomy

目的比较腹腔镜下全膀胱切除术后改良输尿管皮肤造口术和原位回肠新膀胱术治疗高级别或者浸润性膀胱癌的疗效及优缺点。方法纳入膀胱浸润性尿路上皮癌II~III级患者78例,其中60例患者行腹腔镜下全膀胱切除+双侧输尿管经侧腹膜外皮肤造口术(A组),18例采取腹腔镜下全膀胱切除+原位回肠新膀胱术(B组)治疗,观察两组临床疗效(包括手术时间、术中出血量以及术后并发症等)情况。结果A组总手术时间(273.48±49.35)min,术中出血量(342.51±53.47)mL,有16例患者需要围手术期输血,出现淋巴结阳性者2例,术后通气天数(2.9±1.4)天,术后住院天数(12.6±3.2)天。B组在总手术时间、术中出血量、术后通气天数和术后住院天数与A组相比较,差异均存在统计学意义。在术后淋巴结阳性方面,与A组相比较,差异无统计学意义。在术后并发症方面,A组出现肠梗阻和淋巴囊肿的例数较B组更少,两组手术其余并发症的发生率相比,差异无统计学意义。结论腹腔镜下全膀胱切除+双侧输尿管经侧腹膜外皮肤造口术能够加快患者术后康复,减少围手术期并发症,但其远期的临床疗效需要更进一步的研究补充。

Objective This study compared the efficacy,advantages and disadvantages of laparoscopic radical cystectomy plus bilateral extraperitoneal ureterostomy and laparoscopic radical cystectomy plus orthotopic ileal bladder in the treatment of muscle invasive bladder cancer.Methods A total of 78 patients with II~III grade bladder invasive urothelial carcinoma were included.Among them,60 patients received laparoscopic radical cystectomy and bilateral ureterostomy(group A),and 18 cases received orthotopic ileal neobladder after laparoscopic radical cystectomy(group B).The clinical efficacy,operation time,intraoperative blood loss,and complications were assessed between the two groups.Results In group A,the total operation time was(273.48±49.35)min,and the intraoperative blood loss was(342.51±53.47)mL.Sixteen patients needed perioperative blood transfusion,and positive lymph nodes were observed in 2 patients.The postoperative ventilation time was(2.9±1.4)days,and the postoperative hospital stay was(12.6±3.2)days.Significant differences were revealed in total operation time,intraoperative bleeding,drainage tube extraction time and postoperative hospital stay between group B and group A.There was no significant difference in postoperative lymph node positivity between these two groups.In terms of postoperative complications,the number of cases of intestinal obstruction and lymphoid cyst in group A was less than that in group B,and there was no significant difference in the incidence of other complications between the two groups.Conclusion Laparoscopic radical cystectomy and bilateral extraperitoneal ureterostomy can accelerate postoperative recovery and reduce perioperative complications.However,the long-term clinical effect of this surgery needs to be supplemented by further research.