MIBC与NMIBC原位回肠新膀胱术后并发症及功能预后的比较

The prognosis and complications differences between MIBC and NMIBC in the orthotopic ileal neobladder

目的比较肌层浸润性膀胱癌(MIBC)与非肌层浸润性膀胱癌(NMIBC)行根治性膀胱切除术(RC)联合回肠原位新膀胱的并发症及预后结果。方法回顾性分析2010年4月至2021年10月于江苏省人民医院行回肠原位新膀胱术103例患者的临床资料。其中MIBC51例(MIBC组),NMIBC52例(NMIBC组)。MIBC组男49例,女2例;年龄(58.1±8.9)岁;美国麻醉医师协会(ASA)评分1~2分48例,3分3例;行开放RC2例,腹腔镜RC34例,机器人辅助RC 15例。NMIBC组男49例,女3例;年龄(55.7±9.9)岁;ASA评分1~2分51例,3分1例;行腹腔镜RC41例,机器人辅助RC 11例。两组术前一般资料比较差异均无统计学意义(P>0.05)。采用Clavien-Dindo分级系统评估并发症严重程度,Ⅰ~Ⅱ级为轻度并发症,Ⅲ~Ⅴ级为重度并发症。根据并发症与原位新膀胱的相关性分为新膀胱相关及非新膀胱相关并发症。比较两组并发症及原位新膀胱功能预后情况。结果MIBC组与NMIBC组手术时间[(421.2±119.7)min与(439.8±106.2)min]、术中出血量[400(300,700)ml与400(300,625)ml]、淋巴结清扫数量[(14.9±8.3)枚与(14.8±8.5)枚]、肠道功能恢复时间[5(4,6)d与5(3,6)d]、术后住院时间[20(15,28)d与22(19,28)d]差异均无统计学意义(P>0.05)。MIBC组较NMIBC组脉管内癌栓比例更高[23.5%(12/51)与5.8%(3/51),P=0.011],淋巴结转移比例更高[17.6%(9/51)与0(0/52),P=0.001]。NMIBC组的5年总生存率显著优于MIBC组(97.6%与70.2%),差异有统计学意义(P=0.035)。MIBC组与NMIBC组日间需尿垫比例[14.6%(7/46)与6.7%(3/45)]、日间排尿间隔[(2.0±0.7)h与(2.4±0.7)h]、夜间需尿垫比例[47.9%(23/48)与53.3%(24/45)]、夜尿次数[(3.1±1.5)次与(2.3±1.7)次]、夜间需尿垫数量[1(0,1)块与1(0,1)块]、日间尿失禁率[25.0%(12/48)与11.1%(5/45)]、夜间尿失禁率[62.5%(30/48)与62.2%(28/45)]、性功能保留率[15.8%(6/38)与25.0%(10/40)]差异均无统计学意义(P>0.05)。MIBC组与NMIBC组术后轻度并发症[41.2%(21/51)与51.9%(27/52)]、重度并发症[21.6%(11/51)与19.2%(27/52)]、新膀胱相关并发症[27.5%(14/51)与25.0%(13/52)]和非新膀胱相关并发症发生率[39.2%(20/51)与25.0%(13/52)]差异均无统计学意义(P>0.05)。结论NMIBC与MIBC患者原位回肠新膀胱术后在新膀胱功能预后及并发症发生情况方面无显著差异,且NMIBC具有较好的肿瘤学预后。

Objectivee To compare the prognosis and complications of muscle-invasive bladder cancer(MIBC)and non-muscle-invasive bladder cancer(NMIBC)patients undergoing radical cystectomy(RC)followed by ileal neobladder.Methods The clinical data of 103 patients who underwent orthotopic ileal neobladder in Jiangsu Province Hospital from April 2010 to October 2021 were retrospectively analyzed.There were 51 MIBC patients and 52 NMIBC patients.In the MIBC group,there were 49 males and 2 females,aged(58.1±8.9)years,with American Society of Anesthesiologists(ASA)score of 1-2 in 48 cases and 3 in 3 cases.Open radical cystectomy(ORC)was performed in 2 cases,laparoscopic(LRC)in 34 cases and robot-assisted radical cystectomy(RARC)in 15 cases.In the NMIBC group,there were 49 males and3 females,aged(55.7±9.9)years,ASA score of1-2 in 51 cases and ASA score of 3 in 1 case.LRC was performed in 41 cases,and RARC in 11 cases.There were no statistically differences between the two groups in above indicators(P>0.05).The Clavien-Dindo grading system(CCS)was used to assess the complications,defining CCSⅠ-Ⅱas mild complications and CCSⅢ-Ⅴas severe complications.According to their relationship to the neobladder,complications were be classified as neobladder-related and non-neobladder-related complications.The occurrence of complications and the prognosis of neobladder between MIBC and NMIBC were compared.Results The average operation time of the MIBC group and NMIBC group were(421.2±119.7)min vs.(439.8±106.2)min.The blood loss were 400(300,700)ml vs.400(300,625)ml.The frequency of lymph nodes removed were(14.9±8.3)vs.(14.8±8.5).The postoperative defecation time were 5(4,6)d vs.5(3,6)d.And the postoperative hospital stay were 20(15,28)d vs.22(19,28)d.There were no statistically differences between the two groups in above indicators(P>0.05).The MIBC group had a significantly lower rate of pelvic lymph node metastasis[17.6%(9/51)vs.0(0/52),P=0.001]and tumor thrombosis[23.5%(12/51)vs.5.8%(3/51),P=0.011]than the MIBC group.Moreover,the NMIBC group had a considerably superior 5-year overall survival(OS)(97.6%vs.70.2%,P=0.035).The proportion of pads needed in the daytime of the MIBC group and NMIBC group were 14.6%(7/46)vs.6.7%(3/45).The frequency of urination were(2.0±0.7)h vs.(2.4±0.7)h.Furthermore,The proportion of pads needed at night were 47.9%(23/48)vs.53.3%(24/45).The frequency of nocturnal urination were 3.1±1.5 vs.2.3±1.7.And the number of pads needed at night were all 1(O,1)pad.The daytime and nighttime incontinence rate were 25.0%(12/48)and 62.5%(30/48)respectively in MIBC,compared to 11.1%(5/45)and 62.2%(28/45)respectively in NMIBC.And the proportion of erectile function retention were 15.8%(6/38)vs.25.0%(10/40).There were no statistically significant differences in the prognosis of neobladder function between the two groups(P>0.05).Furthermore,the proportions of mild complications in the MIBC group and NMIBC group were[41.2%(21/51)vs.51.9(27/52)].The proportions of severe complications were[21.6%(11/51)vs.19.2%(27/52)].The proportions of neobladder-related complications were[27.5%(14/51)vs.25.0%(13/52)].And the proportions of non-neobladder-related complications were[39.2%(20/51)vs.25.0%(13/52)].There were no statistically significant differences in the complications between the two groups(P>0.05).Conclusions There was no statistically significant difference in functional prognosis and complications of neobladder between MIBC group and NMIBC group,and NMIBC had a better oncologic prognosis.