腹腔镜全膀胱切除术后三种不可控尿流改道并发症的探讨  

Investigation of complication in three incontinent urinary diversions after laparoscopic radical cystectomy

作　　者：汪凯[1] 林连祥[1] 范祎[1] 邰圣城 钟达川[1] 汪星[1] 徐丹枫[2] 

机构地区：[1]浙江萧山医院,浙江杭州311202 [2]第二军医大学附属长征医院

出　　处：《腹腔镜外科杂志》2015年第1期71-74,共4页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜全膀胱切除术后三种不可控尿流改道手术期间、早期及晚期并发症情况。方法:回顾分析2008年12月至2012年7月为82例浸润性膀胱癌患者行腹腔镜全膀胱切除术的临床资料,其中男59例,女23例,平均(62.4±5.3)岁。34例行回肠膀胱术,21例行结肠膀胱术,27例行输尿管皮肤造口术。结果:回肠膀胱术患者术后平均住院(14.0±2.1)d,结肠膀胱术平均(15.8±1.9)d,输尿管皮肤造口术平均(13.6±1.8)d。平均随访(22.4±6.7)个月,回肠膀胱术组手术期间并发症发生率明显高于其他两组(P<0.05),早期并发症3组间差异无统计学意义(P>0.05),晚期并发症回肠膀胱术组显著高于其他两组(P<0.05)。结论:腹腔镜全膀胱切除术适于高风险的患者,且并发症与尿流改道术方法选择密切相关。相较结肠膀胱术、输尿管皮肤造口术,回肠膀胱术的手术期间、晚期并发症发生率最高,而早期并发症3组差异无统计学意义。Objective： To discuss the perioperative,early and late complications of three incontinent urinary diversions after laparoscopic radical cystectomy. Methods： A retrospective study included 82 patients with invasive bladder cancer who underwent laparoscopic radical cystectomy between Dec. 2008 and Jul. 2012. There were 59 males and 23 females with the average age of（ 62. 4 ±5. 3） years. The patients were divided into three groups： ileal conduit（ IC）,colon conduit（ CC）,and uretero-ureterocutaneostomy（ UUCS）. The IC was performed in 34 patients,a CC in 21,and a UUCS in 27 patients,respectively. Results： The mean postoperative hospital stay was（ 14. 0 ± 2. 1） d in IC group,（ 15. 8 ± 1. 9） d in CC group,and（ 13. 6 ± 1. 8） d in UUCS group. The mean follow up was（ 22. 4 ± 6. 7） months,the perioperative complication incidence of IC group was significantly higher than the other groups（ P〈0. 05）. There was no statistical difference in early complications（ P〉0. 05）,and the IC group had the highest rate of late complications among the 3 groups（ P〈0. 05）. Conclusions： Laparoscopic radical cystectomy is suitable for patients with high risk. Complications are closely related to the urinary diversion method selected. The IC has the highest rate of perioperative and late complications.

关 键 词：膀胱切除术 尿流改道术 手术后并发症 腹腔镜检查 

分 类 号：R737.14[医药卫生—肿瘤]