腹腔镜与开放根治性膀胱全切-回肠原位新膀胱术的疗效对比  

Comparison of laparoscopic and open surgery for radical cystectomy with orthotopic ileal neobladder

作　　者：吴鑫[1] 刘沛[1] 朱雨泽 郑卫[1] 唐琦[1] 姚林[1] 张崔建[1] 郝瀚[1] 李学松[1] 周利群[1] 

机构地区：[1]北京大学第一医院泌尿外科北京大学泌尿外科研究所,北京100034

出　　处：《现代泌尿外科杂志》2015年第4期229-233,共5页Journal of Modern Urology

摘　　要：目的：比较开放及腹腔镜根治性膀胱全切-回肠原位新膀胱术的临床疗效。方法回顾性分析我院自2010年9月至2014年3月行开放（ORC）及腹腔镜（LRC）根治性膀胱全切-回肠原位新膀胱术患者的资料，其中ORC组13例，LRC组21例。对两组患者的术前基本资料、围术期数据、术后并发症情况、术后控尿情况及肿瘤学随访数据进行对比分析。结果LRC组较ORC组具有术中出血量少（P＝0．013）、术后恢复进食时间短（P＝0．001）、住院时间短（P＝0．005）的特点。两组在术后并发症发生率方面无明显差异（P＝0．725）。所有患者术后切缘均为阴性，两组患者在淋巴结清扫个数（P＝0．393）以及淋巴结阳性率（P＝0.562）方面无统计学差。中位随访时间28．5个月（8～47个月）。在术后1年内，LRC组与ORC组在日间控尿率（88．2％vs．84．6％，P＝0．773）及夜间控尿率（70．6％vs．76．9％，P＝0．697）无明显差异。在随访过程中，4例患者发生肿瘤复发或转移，其中盆腔复发2例，脑转移1例，肺转移1例。3例患者死亡。LRC组与ORC组在肿瘤特异性生存率及无复发生存率上无统计学差异（P均＞0．05）。结论与开放手术相比，腹腔镜根治性膀胱全切-回肠原位新膀胱术具有术中出血少、术后恢复快的特点，其术后控尿功能及肿瘤学结果与开放手术疗效相当，因此应作为首选手术方案。Objective To compare the clinical outcomes of laparoscopic cystectomy （LRC） and open radical cystectomy （ORC） in the treatment of orthotopic ileal neobladder .Methods The demographic parameters of patients ,perioperative da-ta ,postoperative complications ,new bladder function and oncology results were recorded and evaluated .Results The LRC group had less estimated blood loss （P=0 .013） ,shorter oral intake time （P=0 .001） and hospital stay （P=0 .005） compared with the ORC group . There was no difference in postoperative complications （ P= 0 .725 ） , the mean number of dissected lymph nodes （P=0 .393） ,and lymph node positive rate （P=0 .562） between the two groups .The median follow-up was 28 .5 months （8~47 months） .One year after operation ,the day-time and night-time continence rate were 88 .2% and 70.6% for the LRC group ,84 .6% and 76 .9% for the ORC group （P〉0 .05） ,with no statistical significance .During the follow-up ,4 patients developed tumor recurrence and metastasis .There was no significant difference in cancer-specific survival rates and re-currence-free survival rates between the two groups （all P〉0 .05 ） .Conclusions Compared with open radical cystectomy , laparoscopic cystectomy has advantages of less blood loss ,earlier oral intake and shorter hospital stay in the treatment of ortho-topic ileal neobladder .Additionally ,it produces comparable continence and tumor control as open radical cystectomy;there-fore ,laparoscopic cystectomy should be the optimal treatment modality .

关 键 词：膀胱肿瘤 腹腔镜 回肠新膀胱 根治性膀胱切除 

分 类 号：R737.14[医药卫生—肿瘤]