腹腔镜膀胱全切回肠膀胱术与原位回肠新膀胱术近期疗效比较  

Short-term efficacy after laparoscopic radical cystectomy:comparison of ileal conduit to orthotopic ileal neobladder

作　　者：张鑫[1] 王德林[1] 吴小侯[1] 陈在贤[1] 蒲军[1] 张尧[1] 何云峰[1] 刘文聪[1] 何祥彪 

机构地区：[1]重庆医科大学附属第一医院泌尿外科,400016

出　　处：《重庆医学》2015年第16期2194-2196,2199,共4页Chongqing medicine

基　　金：重庆市科学技术委员会科技攻关项目(cstc2012gg-yyjs10043);重庆市卫生和计划生育委员会医学科研计划项目(2013-2-082)

摘　　要：目的 总结腹腔镜膀胱全切回肠（Bricker）膀胱术与原位回肠（Hautmann）新膀胱术治疗浸润性膀胱癌的经验及近期疗效。方法 该院2010~2014年施行腹腔镜Bricker膀胱术74例,Hautmann新膀胱术30例,回顾性分析比较两组患者手术时间、出血量等术中情况、术后肠道功能恢复、术后并发症及术后肿瘤复发转移等临床资料。结果 两组在平均手术时间、术中出血量、术中输血率、盆腔淋巴结清扫数目、术后住院时间等方面差异无统计学意义（P〉0.05）。两组淋巴结阳性共8例（7.8%）,合并前列腺癌3例（2.9%）,无切缘阳性病例。Bricker膀胱术组、Hautmann新膀胱术组术后肠道功能恢复时间分别为（4.2±1.4）、（5.3±2.2）d,P=0.002,并发症发生率分别为31.9%（23例）、53.3%（16例）,P=0.043。Hautmann新膀胱术组患者术后6个月白天和夜间尿控分别为76.9%、57.7%,术后12个月白天和夜间尿控分别为90.9%、81.8%。Hautmann新膀胱术组术后2例（7.7%）复发转移,Bricker膀胱术组术后9例（14.1%）复发转移。结论 Bricker膀胱术和Hautmann新膀胱术具有相似肿瘤根治效果,但Hautmann新膀胱术患者术后生活质量更高。Objective To summary the experience of laparoscopic cystectomy ileal conduit （Bricker） and orthotopic ileal neo- bladder （Hautmann） and compare the short-term efficacy of the two types of urinary diversion for invasive bladder cancer. Methods Retorspective analysis of the patients in our hospital who accepted laparoscopic radical eystectomy from 2010 to 2014 was performed,74 of them accepted ileal conduit,and 30 of them accepted orthotopie ileal neobladder. The general clinical data,postop- erative recovery,postoperative complications and Oncology feature were analyzed and compared between the two groups. Results There was no demonstrable difference was found in operation time,blood Ioss,intraoperative blood transfusion rate, the number of removed lymph node, average hospital stay, specimens positive margin rate and postoperative pathology results between the two groups （P〉0.05）. But there were significant difference in postoperative intestinal function recovery time[（4.2 ± 1.4）d, （5.3±2.2） d], （P= 0. 002）, and the complication rates 31.9 % （23 cases）vs. 53.3 % （16 case）, P= 0. 043. After 6 months, the daytime and nighttime urinary control were 76.9%, 57.7%, after 12 months, the daytime and nighttime urinary control increased to 90.9 %, 81.8 %. 2 eases（7.7 %） were diagnosed with recurrence or metastasis during follow-up in Hautmann group,while 9 cases（14.1 %） were diagnosed with recurrence or metastasis in Bricker group. Conclusion Two kinds of surgical procedures both have the similar therapeutic effect,but the postoperative quality of life is better for Hautmann orthotopic neobladder patients.

关 键 词：膀胱肿瘤 新膀胱切除术 腹腔镜检查尿流改道术 原位回肠新膀胱 

分 类 号：R737.14[医药卫生—肿瘤]