经腹腔入路与经腹膜外入路腹腔镜下根治性全膀胱切除术治疗膀胱癌的效果对比

Comparison of therapeutic effects of laparoscopic radical cystectomy via intraperitoneal approach and via extraperitoneal approach on bladder cancer

目的比较经腹腔入路与经腹膜外入路腹腔镜下根治性全膀胱切除术(RC)治疗膀胱癌的临床效果。方法前瞻性研究。抽取2020年6月至2023年6月于南阳市中心医院拟行腹腔镜下RC治疗的90例膀胱癌患者作为研究对象,经随机数字表法分为对照组与观察组,每组45例。对照组采用经腹腔入路腹腔镜下RC治疗,观察组采用经腹膜外入路腹腔镜下RC治疗。比较两组围术期指标、淋巴结清扫数量、肠道功能、术后并发症发生情况及短期预后情况。结果观察组住院时间短于对照组,差异有统计学意义(P<0.05);两组手术时间、术中出血量、引流管拔除时间以及淋巴结清扫数量比较,差异未见统计学意义(P>0.05)。观察组术后首次排气时间、恢复进食时间短于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率(6.67%,3/45)低于对照组(22.22%,10/45),P<0.05。随访6个月,两组复发率比较差异未见统计学意义(P>0.05)。结论经腹腔入路和经腹膜外入路腹腔镜下RC治疗膀胱癌的效果相当,但后者住院时间更短,肠道功能恢复更快,且术后并发症发生率更低。

Objective To compare the clinical effects of laparoscopic radical cystectomy(RC)via intraperitoneal approach and via extraperitoneal approach in the treatment of bladder cancer.Methods A prospective study was adopted in this study.A total of 90 patients with bladder cancer who were scheduled to receive laparoscopic RC treatment in Nanyang Central Hospital from June 2020 to June 2023 were selected as the study subjects.And they were divided into a control group and an observation group by random number table method,with 45 cases in each group.The control group received laparoscopic RC treatment via intraperitoneal approach,while the observation group received laparoscopic RC treatment via extraperitoneal approach.The perioperative indicators,number of lymph node dissection,intestinal function,incidence of postoperative complications,and short-term prognosis were compared between the two groups.Results The hospital stay of the observation group was shorter than that of the control group(P<0.05).There was no significant difference between the two groups in terms of surgical time,intraoperative blood loss,drainage tube removal time,and number of lymph node dissection(P>0.05).The postoperative first exhaust time and resumption of eating time in the observation group were shorter than those in the control group(P<0.05).The incidence of postoperative complications(6.67%,3/45)in the observation group was lower than that in the control group(22.22%,10/45),with a statistical significant difference(P<0.05).After a 6-month follow-up,there was no statistical significant difference in recurrence rate between the two groups(P>0.05).Conclusions Laparoscopic RC treatment via intraperitoneal approach and via extraperitoneal approach have similar effects in the treatment of bladder cancer;however,the latter has shorter hospital stay,faster recovery of intestinal function,and lower incidence of postoperative complications.