腹腔镜膀胱全切回肠膀胱术治疗浸润性膀胱癌疗效分析  

The curative effect of laparoscopic radical cystectomy and Bricker operation in the treatment of patients with invasive bladder cancer

作　　者：汤亚箐 冉磊[1] 唐澜 TANG Ya-qing;RAN Lei;TANG Lan(Institute of Urology/Urology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院泌尿外科/泌尿外科研究所

出　　处：《实用医院临床杂志》2019年第4期101-104,共4页Practical Journal of Clinical Medicine

摘　　要：目的探讨腹腔镜膀胱全切回肠膀胱术(Bricker术)治疗浸润性膀胱癌的疗效。方法我院收治的浸润性膀胱癌患者94例,依据手术方式不同分为观察组(行腹腔镜Bricker术,n=64)、对照组(行原位回肠Hautmann新膀胱术,n=30),分析两组手术相关情况、肠道功能恢复、术后生活质量变化、并发症、肿瘤复发转移等临床资料。结果观察组手术时间、肠道功能恢复时间较对照组缩短(P<0. 05),两组术中出血量、盆腔淋巴结清扫个数、淋巴结阳性率、术后住院时间比较差异无统计学意义(P>0. 05);术后6月两组生活质量各项评分均升高,观察组心理方面评分低于对照组(P<0. 01);观察组术后1年内并发症发生率低于对照组(P<0. 05);两组病死率、生存率、复发转移率比较差异无统计学意义(P>0. 05)。结论腹腔镜膀胱全切后经Bricker术进行尿流改道可最大限度接近生理排尿特点,术后恢复快,并发症少,但患者心理状态不佳,因此对于年龄高、手术耐受力差患者首选Bricker膀胱术,对一般情况好、术后生活质量要求高的患者Hautmann新膀胱术为理想术式。Objective To investigate the curative effect of laparoscopic radical cystectomy and ileal conduit (Bricker operation) in the treatment of patients with invasive bladder cancer.Methods Ninety-four patients with invasive bladder cancer admitted to our hospital were divided into observation group (laparoscopic Bricker operation,n = 64) and control group (Hautmann orthotopic ileal neobladder,n = 30) according to different surgical methods.The clinical data such as surgical related conditions,intestinal function recovery,changes of postoperative quality of life,complications and recurrence and metastasis of tumor were retrospectively analyzed.Results The operation time and recovery time of intestinal function in the observation group were significantly shorter than those in the control group (P<0. 05).There was no significant difference in the intraoperative blood loss,number of pelvic lymph node dissection,positive rate of lymph node or postoperative hospital stay between the two groups (P > 0. 05). The scores of quality of life in the two groups were increased after 6 months of operation. The score of mentality in the observation group was lower than that in the control group (P<0. 01).The incidence of complications in the observation group was lower than that in the control group within 1 year after operation (P<0. 05).There was no significant difference in the mortality,survival rate and recurrence rate between the two groups (P>0. 05).Conclusion The urinary flow diversion by Bricker operation after laparoscopic radical cystectomy can be as close as possible to the characteristics of physiological urination with quick postoperative recovery and few complications.However,the psychological state of patients is not good.Therefore,Bricker operation is preferred for patients with old age and poor surgical tolerance.Hautmann neobladder is an ideal procedure for patients with good general condition and high postoperative quality of life.

关 键 词：腹腔镜膀胱全切 Bricker膀胱术 浸润性膀胱癌 疗效 心理状态 

分 类 号：R737.25[医药卫生—肿瘤]