腹腔镜下与开放式根治性膀胱切除术后早期并发症的对比研究  

Comparison of early stage complications between laparoscopic cystectomy and open radical cystectomy

作　　者：曾蜀雄[1] 张振声[1] 宋瑞祥[1] 于晓雯[2] 鲁欣[1] 李惠珍[1] 陈新[1] 马重[1] 赵俊杰[1] 孙颖浩[1] 许传亮[1] 

机构地区：[1]第二军医大学长海医院泌尿外科,上海200433 [2]第二军医大学长海医院老年科,上海200433

出　　处：《中华泌尿外科杂志》2015年第5期333-336,共4页Chinese Journal of Urology

基　　金：上海市卫生系统优秀人才培养计划（XBR2013076）

摘　　要：目的 比较腹腔镜下根治性膀胱切除术（laparoscopic radical cystectomy,LRC）与开放式根治性膀胱切除术（open radical cystectomy,ORC）术后早期并发症的发病特点.方法 收集2011年9月至2014年5月行根治性膀胱切除手术且随访资料完整的患者201例,其中96例行LRC,男86例,女10例,平均年龄（63.7±10.5）岁;105例行ORC,男86例,女19例,平均年龄（64.4±11.4）岁,比较两组患者的手术时间、术中出血量、术后输血例数、术后排气时间、恢复进食时间、引流管拔除时间、术后90 d内早期并发症发生情况等.结果 LRC组和ORC组的手术时间分别为389 min和321 min,术中出血量分别为420 ml和591 ml,术后输血例数分别为15例和29例,术后住院时间分别为16.5d和18.5d,差异均有统计学意义（P＜0.05）.LRC组和ORC组术后排气时间分别为3.7d和3.5d,恢复进食时间分别为4.4d和4.3d,引流管拔除时间分别为11.1d和10.9d,差异均无统计学意义（P＞0.05）.LRC组和ORC组术后并发症发生率分别为28.1％（27/96）和43.8％ （46/105）,差异有统计学意义（P＜0.05）.LRC组并发症以感染（7例）、肠梗阻（7例）、淋巴漏（7例）常见,ORC组以感染（14例）、肠梗阻（13例）、切口脂肪液化（11例）常见,LRC组切口脂肪液化1例,与ORC组比较差异有统计学意义（P＜0.05）.结论 与ORC比较,LRC能显著减少患者术中出血量,降低术后早期并发症的发生率,缩短术后住院时间.Objective To compare the incidence and characteristics of early stage complications between laparoscopic radical cystectomy （LRC） and open radical cystectomy （ORC）.Methods From September 2011 to May 2014,we retrospectively analyzed the demographic,perioperative data of 96 （86 males and 10 females） and 105 （86 males and 19 females） patients who had undergone LRC and ORC,respectively.The average age of patients was（64.4 ± 11.4） and （63.7 ± 10.5） years old in ORC and LRC group,respectively.We collected operation time,estimated blood loss,number of transfusion,time to resumption of oral intake,postoperative length of drainage freeand complication rate within 90 days after cystectomy.Categorical variables were analyzed with the 2 test or Fisher＇s exact test as appropriate.Continuous variables were compared using the Student＇s t-test.Results Mean operative time was significantly longer in LRC group than ORC group （389 vs 321 min,P =0.02）.However mean estimated blood loss,postoperative length of stay was significantly less in LRC group than in ORC group （420 vs 591 ml,P =0.003 and 16.5 vs 18.5 d,P =0.04）,respectively.Fewer patients in the LRC group need blood transfusion than in ORC group （15 vs 29 patients,P =0.042）.The complication rate was significantly less in LRC group as well （28.1% vs 43.8%,P =0.027）.No significant differences were found in time resume the intestinal function（3.7 vs 3.5 d）,time to resumption of oral intake （4.4 vs 4.3 d）and time to remove the drainage tube （11.1 vs 10.9 d） between two groups,respectively （P 〉0.05）.The incidence of early complication in LRC group was significant lower than that in ORC group（28.1% vs 43.8%,P 〈0.05） The common complications following LRC were infection （n =7）,intestinal obstruction （n =7）,lymphatic leak （n =7）,while ORC group was infection （n =14）,intestinal obstruction （n =13） and liquefied fat （n =11）.The incidence of liquefied fat of abdominal incision was significantly

关 键 词：膀胱癌 腹腔镜 开放 根治性膀胱切除术 并发症 

分 类 号：R737.14[医药卫生—肿瘤]