膀胱癌根治性全膀胱切除术后三种不同尿流改道方式的临床疗效及对患者生活质量的影响  

Clinical Efficacies of Three Different Urinary Diversion Methods and Their Effects on Quality of Life of Bladder Cancer Patients after Radical Cystectomy

作　　者：徐宝海[1] 余义[1] 熊丙健 XU Bao-hai;YU Yi;XIONG Bing-jian(Department of Urology Surgery,Central Hospital of Ankang,Ankang,Shaanxi 725000,China)

机构地区：[1]安康市中心医院泌尿外科,陕西安康725000

出　　处：《解放军医药杂志》2018年第9期20-23,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：陕西省自然科学基金资助项目(2017JM8084)

摘　　要：目的探讨膀胱癌根治性全膀胱切除术后3种不同尿流改道方式的临床疗效及对患者生活质量的影响。方法选取2012年1月—2017年8月行根治性全膀胱切除尿流改道治疗的114例膀胱癌患者作为研究对象。根据尿道改流方式不同分为A组48例、B组36例和C组30例,A组予以回肠原位新膀胱尿流改道,B组予以回肠代膀胱尿流改道,C组予以输尿管皮肤造口尿流改道。记录并比较3组的手术情况、生活质量和并发症的发生情况。结果A组和B组的手术时间和住院时间长于C组,术中出血量多于C组(P<0.05)。3组的并发症发生率比较差异无统计学意义(P>0.05)。A组的生理机能、生理职能、社会功能和精神健康评分高于B组和C组(P<0.05)。结论在根治性全膀胱切除术中采用3种尿流改道对膀胱癌患者均具有一定的临床疗效和安全性,但采用回肠原位新膀胱尿流改道更有利于提高患者术后生活质量。Objective To investigate clinical efficacies of three different urinary diversions methods and their effects on quality of life of bladder cancer patients after radical cystectomy.Methods A total of 114 bladder cancer patients undergoing radical cystectomy and urinary diversion during January 2012 and August 2017 were divided into group A （ n =48）, group B （ n =36） and group C （ n =30） according to different urinary diversion methods. Group A was treated with ileum in situ of new bladder urinary diversion, and group B was reformed by ileum bladder urinary flow, while group C was given ureterostomy of urinary diversion. Operative condition, quality of life and incidence rate of complications were recorded and compared among 3 groups.Results In group A and B, operative time and length of stay were significantly longer than those in group C, while intraoperative bleeding volume was larger than that in group C （ P 〈 0.05）. There was no significant difference in incidence rate of complications among 3 groups （ P 〉0.05）. Scores of physiological function, physiological function, social function and mental health in group A were significantly higher than those in group B and C （ P 〈0.05）.Conclusion Three different urinary diversions methods for bladder cancer patients after radical cystectomy have a certain clinical efficacy and safety, but ileum in situ of new bladder urinary diversion method is more beneficial to improve postoperative quality of life.

关 键 词：膀胱肿瘤 膀胱切除术 尿流改道术 生活质量 

分 类 号：R737.14[医药卫生—肿瘤]