腹膜外入路腹腔镜下根治性膀胱切除术临床效果评估及应用价值

Evaluation of clinic outcomes and application value of extraperitoneal laparoscopic radical cystectomy

目的 比较经腹腔入路和经腹膜外入路腹腔镜下根治性全膀胱切除术(RC)2种手术的临床应用价值。方法 回顾性分析2018-03-01-2020-03-01在福建医科大学附属第二医院行腹腔镜下RC的76例膀胱癌患者临床资料。经腹腔入路腹腔镜下RC(TLRC)患者30例(TLRC组);保留腹膜完整性的腹膜外入路腹腔镜下RC(ELRC)患者46例(ELRC组)。采用独立t检验、χ^(2)检验及Fisher精确概率法比较2组患者临床资料的统计学意义。结果 ELRC组通气时间[(4.46±0.94)vs(5.07±1.20) d;t=2.481,P=0.015]、液体摄入时间[(1.80±1.28)vs(2.60±1.52) d;t=2.461,P=0.016]和住院时间[(20.61±12.13)vs(25.85±8.32) d;t=2.235,P=0.028]较TLRC组缩短。TLRC组和ELRC组发生肠麻痹患者分别为9(30.0%)和4例(8.7%),发生肠梗阻患者分别为9(30.0%)和3例(6.5%),ELRC组肠麻痹及肠梗阻的发生率均低于TLRC组,χ^(2)值分别为5.812和5.866,P值分别为0.016和0.015。而在手术时间、术中出血量、淋巴结数量、其他并发症发生率及病理结果等方面,2组间差异均无统计学意义。所有患者均未出现切缘阳性情况。随访结果显示,2组间总生存期、肿瘤特异性生存期和无肿瘤生存期差异无统计学意义,均P>0.05。结论 腹膜外入路腹腔镜下RC可以改善围手术期的结果,促进患者康复。因此,保留腹膜完整性的ELRC是有前景的改良手术。

Objective To compare the advantages and disadvantages of laparoscopic radical cystectomy via peritoneal ap-proach or extraperitoneal approach.Methods The clinical data of 76 patients with bladder cancer who underwent laparo-scopic radical cystectomy(RC)in the Second Affiliated Hospital of Fujian Medical University from March 1,2018 to March 1,2020 were retrospectively analyzed.Thirty patients underwent transperitoneal laparoscopic radical cystectomy(TLRC group).The remaining 48 were conducted extraperitoneal laparoscopic radical cystectomy(ELRC group).Inde-pendent t-tests,x test,and Fishers exact probability method were used to compare the statistical significance of clinical data between two groups.Results A significantly shorter time to ventilation[(4.46±0.94)us(5.07±1.20)d;t=2.481,P=0.015]and liquid intake[(1.80±1.28)us(2.60±1.52)d;t=2.461,P=0.016]were observed in ELRC group compared with TLRC group,and ELRC group was associated with a shorter hospital stay[(20.61±12.13)us(25.85±8.32)d;t=2.235,P=0.028].The cases of enteroparalysis in TLRC group and ELRC group were 9 cases(30.0%)and 4 cases(8.7%)respectively.The cases of intestinal obstruction in TLRC group and ELRC group were 9 cases(30.0%)and 3 cases(6.5%)respectively.The incidence of erteroparalysis and intestinal obstruction in ELRC both were lower than TLRC group,x value were 5.812 and 5.866,respectively,and P value were 0.016 and 0.015,respectively.These two approaches did not differ with regard to operating time,intraoperative blood loss,lymph node count,other complications or pathological outcomes.No patient in either group had positive surgical margins.There were no significant differences between the two groups in the overall survival,cancer-specific survival,or cancer-free survival rates based on the follow-up data.Conclusions The results suggest that ELRC could improve the perioperative outcomes and promote the rehabilitation of patients.Thus,ELRC,which preserves the integrality of peritoneum,is a promising modified surgery.