摘要
目的探究腹腔镜下膀胱癌根治性切除术后不同尿流改道方式的临床效果。方法选择我院2015年1月至2019年6月收治的膀胱癌患者42例为研究对象,均采用腹腔镜下膀胱癌根治性切除术治疗,根据术后尿流改道方式不同分为原位回肠新膀胱组(原位组)10例、回肠导管组20例与输尿管腹壁造口组12例。比较三组尿流改道术手术时间、术后开始进食时间、下地时间及住院时间,随访15个月评价生活质量,比较三组近远期并发症发生情况。结果输尿管腹壁造口组手术时间短于原位组、回肠导管组,术后开始进食时间、下地时间及住院时间短于原位组、回肠导管组,差异有统计学意义(P<0.05);原位组术后15个月生理领域、心理领域评分高于回肠导管组、输尿管腹壁造口组,差异有统计学意义(P<0.05),原位组社会关系领域、环境领域评分高于输尿管腹壁造口组,差异有统计学意义(P<0.05),原位组社会关系领域、环境领域评分与回肠导管组比较,差异无统计学意义(P>0.05);回肠导管组生理领域、心理领域、社会关系领域、环境领域评分均高于输尿管腹壁造口组,差异有统计学意义(P<0.05);近期并发症总发生率,原位组为40.00%、回肠导管组为45.00%、输尿管腹壁造口组为41.67%,远期并发症总发生率,原位组为30.00%、回肠导管组为55.00%、输尿管腹壁造口组为41.67%,差异均无统计学意义(P>0.05)。结论腹腔镜下膀胱癌根治性切除术后尿流改道采用原位回肠新膀胱术更符合生理排尿特点,术后生活质量较高,并发症少。
Objective To explore the clinical effect of different urinary diversion methods after laparoscopic radical cystectomy for bladder cancer.Methods A total of 42 patients with bladder cancer(BC)admitted to our hospital from January 2015 to June 2019 were selected as the subjects of research,and all of them were treated with laparoscopic radical cystectomy for BC.They were divided into the orthotopic ileal neobladder group(the orthotopic group,n=10),the ileal conduit group(n=20)and the ureter-abdomen ostomy group(n=12).The operation time of urinary diversion,the time to start eating after operation,the time of getting off bed and the hospitalization time were compared among the three groups.The quality of life(QoL)was evaluated after 15 months of follow-up,and the shortterm and long-term complications of the three groups were compared.Results The operation time of the ureterabdomen ostomy group was shorter than that of the orthotopic group and the ileal conduit group,and the time to start eating after operation,the time of getting off bed and the hospitalization time were shorter than those of the orthotopic group and the ileal conduit group,with statistically significant differences(P<0.05).15 months after operation,the scores of physiological and psychological domains of the orthotopic group were higher than those of the ileal conduit group and the ureter-abdomen ostomy group,and the differences were statistically significant(P<0.05).The scores of social relation domain and environmental domain of the orthotopic group were higher than those of the ureter-abdomen ostomy group,with statistically significant difference(P<0.05),but when they were compared with those of the ileal conduit group,the difference was statistically insignificant(P>0.05).The scores of physiological domain,psychological domain,social relation domain and environmental domain of the ileal conduit group were all higher than those of the ureter-abdomen ostomy group,and the differences were statistically significant(P<0.05).As far as short-term complications were concerned,the incidence in the orthotopic group was 40.00%,while that in the ileal conduit group was 45.00%and that in the ureter-abdomen ostomy group was 41.67%;As far as long-term complications were concerned,the incidence in the orthotopic group was 30.00%,while that in the ileal conduit group was 55.00%and that in the ureter-abdomen ostomy group was 41.67%,and all these differences were statistically insignificant(P>0.05).Conclusion After laparoscopic radical cystectomy for bladder cancer,urinary diversion with orthotopic ileal neobladder caters to the characteristics of physiological urination better,the QoL is higher and the complications are fewer after operation.
作者
程伟文
吴栩君
陈光耀
陈咏佳
敖智宪
林燕文
CHENG Weiwen;WU Xujun;CHEN Guangyao;CHEN Yongjia;AO Zhixian;LIN Yanwen(First Department of Urology,the People's Hospital of Yangjiang City,Guangdong,Yangjiang 529500,China)
出处
《中国医药科学》
2021年第8期204-208,共5页
China Medicine And Pharmacy
基金
广东省阳江市医疗卫生类科技计划项目(阳科通﹝2019﹞50号33)。
关键词
腹腔镜
膀胱癌根治性切除术
尿流改道术
并发症
生活质量
Laparoscopy
Radical cystectomy for bladder cancer
Urinary di version
complications
Quality of life
