根治性膀胱切除术后回肠通道腹膜外化处理的必要性  

Analysis of the necessity of extraperitonealization in ileal conduit surgery after radical cystectomy

作　　者：刘方明[1] 金迪[1] 沈文浩[1] 曹明[1] 张连华[1] 张瑞赟 董樑[1] 薛蔚[1] 黄翼然[1] 陈海戈[1] 

机构地区：[1]上海交通大学医学院附属仁济医院泌尿外科,200127

出　　处：《中华泌尿外科杂志》2017年第5期352-356,共5页Chinese Journal of Urology

基　　金：国家自然科学基金（81672514）;上海申康医院发展中心临床科技创新项目（SHDC12015125）

摘　　要：目的探讨根治性膀胱切除术后行回肠通道术时关闭腹膜的必要性。方法回顾性分析2014年1月至2016年9月我院行根治性膀胱切除术的395例膀胱癌患者的临床资料。男327例，女68例。平均年龄（65.8±9.7）岁。根据膀胱切除方式及尿流改道方式分为4组。开放式根治性膀胱切除联合腹膜外回肠通道术（A组）87例，男78例，女9例；平均年龄（67.8±9.2）岁；术前临床分期≤T2期66例，〉T2期21例；术前病理分级为高级别83例，低级别4例。开放式根治性膀胱切除联合不关闭腹膜的回肠通道术（B组）33例，男31例，女2例；平均年龄（67.3±8.7）岁；≤T2期25例，〉T2期8例；均为高级别。腹腔镜下根治性膀胱切除联合不关闭腹膜的回肠通道术（C组）139例，男112例，女27例；平均年龄（64.3±10.5）岁；≤T2期107例，〉T2期32例；高级别135例，低级别4例。机器人辅助根治性膀胱切除联合不关闭腹膜的回肠通道术136例（D组），男106例，女30例；平均年龄（65.9±10.0）岁；≤T2期103例，〉T2期33例；高级别132例，低级别4例。不关闭腹膜的回肠通道术即行尿流改道术时输尿管肠吻合后腹膜不关闭，完全敞开，区别于关闭腹膜的腹膜外回肠通道术。比较4组的手术时间、术中出血量、输血率、肠道功能恢复时间、并发症及术后6个月肾积水发生率。结果本研究395例手术均顺利完成，C、D组均未中转开放。A、B、C、D组手术时间分别为（280.1±92.3）、（233.6±99.4）、（304.8±108.9）、（364.6±86.4）min，差异有统计学意义（P〈0.05）；术中出血量分别为（489.1±285.6）、（431.8±233.1）、（373.0±213.7）、（205.6±137.8）ml，差异有统计学意义（P〈0.05）；输血例数分别为18例（20.7%）、16例（48.0%）、15例（10.8%）、14例（10.3%），差异有统计学意义（P〈0.05）。A、B、C、D组术后排气时间分别为（3.7Objective To discuss the necessity of closing the peritoneum during the operation of ileal conduit after the radical cystectomy. Methods We retrospectively analyzed the clinical data of 395 patients with bladder cancer who received radical cystectomy from Jan. 2014 to Sep. 2016. The amount of male was 327,female was 68. The mean age was （65.8 ±9.7） years old. Patients were divided into fourgroups according to the surgical method of cystectomy and urinary diversion. In group A, patients, including 78 males and 9 females, were received open radical cysectomy （ORC） with extraperitoneal ileal conduit. The mean age was （67.8 ± 9.2） years old. In the preoperative clinical staging, 66 cases were less than T2 and 21 cases were more than T2. Preoperative pathological grade in 83 cases and low grade in 4 cases. In group B, patients, including 31 males and 2 females, were accepted ORC with ileal conduit without peritoneum closure. The mean age was （67. 3 ± 8. 7 ） years old . Preoperative clinical staging showed less than T2 in 25 cases, more than T2 in 8 cases, The preoperative pathological grade showed high grade in 33 cases. In group C, patients, including 112 males and 27 females, were accpeted LRC with ileal conduit without peritoneum closure. The mean age was （64. 3 ± 10. 5 ） years old. The preoperative clinical staging showed less than T2 in 107 cases and more than T2 in 32 cases. The preoperative pathological grade showed high grade in 135 cases and low grade in 4 cases. In group D, patients, including 106 males and 30 females, were accepted RARC with ileal conduit without peritoneum closure. The mean age was （65.9 ± 10. 0）years old. Preoperative clinical staging showed less than T2 in 103 cases and more than T2 in 33 cases. The preoperative pathological grade showed high grade in 132 cases and low grade in 4 cases. Ileal conduit without peritoneum closure means completely open the peritoneum after anastomosis of the ureter and intestine in the urinary diversion surgery without shutting d

关 键 词：根治性膀胱切除术 并发症 术后恢复 尿流改道术 腹膜未关闭的回肠通道术 

分 类 号：R737.14[医药卫生—肿瘤]