膀胱癌根治术后尿流改道Bricker与Wallace回肠膀胱的疗效比较

Comparative analysis of clinical efficacy between Bricker and Wallace ileal conduits in urinary diversion after radical cystectomy

目的研究膀胱癌根治术后尿流改道Bricker与Wallace术式的疗效。方法采用回顾性病例对照研究,收集2017年1月~2018年1月新疆维吾尔自治区喀什地区第二人民医院收治的膀胱癌根治术后输尿管回肠肠襻吻合的患者102例,其中尿流改道采用Wallace术式(改良回肠膀胱术)的51例作为观察组,采用Bricker术式(回肠膀胱术)的51例作为对照组,比较两组的围术期指标、术后并发症、预后情况及生活质量。结果观察组手术时间与术后盆腔引流时间短于对照组(P<0.05),泌尿系感染、肠梗阻、漏尿、输尿管肠吻合口狭窄、左肾积水的发生率均低于对照组(P<0.05)。术后随访60个月,两组5年生存率、复发转移率比较无统计学差异(P>0.05)。根据简明健康调查问卷量表(MOS 36-item short-form health survey,SF-36),术后观察组的生理功能(physical function,PF)、生理职能(role physical function,RP)、活力(vitality,VT)、社会功能(social function,SF)、情感职能(role emotion,RE)高于对照组,而躯体疼痛(bodily pain,BP)、总体健康(general health status,GH)、精神健康(mental health,MH)等评分无明显差异(P>0.05)。结论Wallace术式能够缩短手术时间与术后盆腔引流时间,降低并发症发生率,提高术后生活质量。

Objective To compare the efficacy of Bricker(ileal bladder operation)and Wallace(modified ileal bladder operation)on ileal bladder diversion after radical bladder cancer surgery.Methods Fifty-one cases of urinary flow rerouted by Wallace operation after radical bladder cancer surgery in the Kashi Second People's Hospital of Xinjiang Uygur Autonomous Region from January 2017 to January 2018 were collected as the observation group,and 51 cases of Bricker operation were collected as the control group.It was analyzed of the perioperative indexes,postoperative complications,prognosis of the patients after radical bladder cancer surgery.Results Operation time and pelvic drainage time of the observation group was shorter than that of the control group(P>0.05),and the incidence rates of urinary infection,intestinal obstruction,urine leakage,uretero-enterostomy stenosis,and left renal hydronephrosis were lower than that of the control group(P<0.05).After 60 months of follow-up,there was no statistical difference in the survival rate and the recurrence and metastasis rate between the two groups(P>0.05).According to the MOS 36-item short-form health survey(SF-36),the physical function(PF),the role physical function(RP),the vitality(VT),the social function(SF)and the role emotion(RE)of the observation group were higher(P<0.05),but bodily pain(BP),the general health status(GH),and the mental health(MH)were similar(P>0.05).Conclusion Wallace operation can shorten operation time and pelvic drainage time after operation,and reduce the complication rates,so as to improve the quality of life of the ileal bladder diversion patients after radical bladder cancer surgery.