RARC+体内或体外回肠通道术的并发症和预后比较  

Robot-assisted radical cystectomy with total intracorporeal ileal conduit:comparative analysis with extracorporeal ileal conduit

作　　者：田家乐 云天纬 张威[1] 邓永明[1] 林廷升 孙逸凡 杨荣[1] 张士伟[1] 甘卫东[1] 李笑弓[1] 张古田[1] 郭宏骞[1] Tian Jiale;Yun Tianwei;Zhang Wei;Deng Yongming;Lin Tingsheng;Sun Yifan;Yang Rong;Zhang Shiwei;Gan Weidong;Li Xiaogong;Zhang Gutian;Guo Hongqian(Department of Urology,Nanjing Drum Tower Hospital,Nanjing 210008,China;Southeast University School of Medicine,Nanjing 210009,China)

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,210008 [2]东南大学医学院,南京210009

出　　处：《中华泌尿外科杂志》2021年第7期524-529,共6页Chinese Journal of Urology

摘　　要：目的比较机器人辅助根治性膀胱切除术(RARC)+体内回肠通道术(ICUD)或体外回肠通道术(ECUD)的并发症和预后结果。方法回顾性分析2016年3月至2019年6月南京大学医学院附属鼓楼医院收治的95例膀胱癌患者的病例资料,患者均行RARC,其中行ICUD 37例,行ECUD 58例。ICUD组男32例,女5例;年龄(68.0±7.8)岁;体质指数(24.1±3.4)kg/m^(2);美国麻醉医师协会(ASA)评分1~2分4例(10.8%),3~5分33例(89.2%);术前血红蛋白(126.5±14.2)g/L,白蛋白(39.0±2.2)g/L,C反应蛋白4.0(2.0~8.5)mg/L。ECUD组男53例,女5例;年龄(67.5±9.0)岁;体质指数(24.2±3.6)kg/m^(2);ASA评分1~2分16例(27.6%),3~5分42例(72.4%);术前血红蛋白(129.0±12.4)g/L,白蛋白(38.2±3.1)g/L,C反应蛋白4.9(3.1~14.4)mg/L。两组术前资料比较差异均无统计学意义(P>0.05)。两组的RARC和盆腔淋巴结清扫方法相同,ICUD组在完全腔镜下行回肠通道术,ECUD组经下腹正中切口直视下完成回肠通道术。ICUD组和ECUD组术中行扩大盆腔淋巴结清扫术分别为32例(86.5%)和46例(79.3%),差异无统计学意义(P=0.374)。根据Clavien-Dindo分级系统对并发症进行分级。比较两组的围手术期并发症和预后。结果ICUD组和ECUD组的手术时间分别为(430±63)min和(410±69)min(P=0.163),估计失血量分别为(435±233)ml和(388±277)ml(P=0.182),术中输血分别为10例(27.0%)和12例(20.7%)(P=0.475),差异均无统计学意义。ICUD组和ECUD组术后白蛋白分别为(31.5±2.4)g/L和(31.0±2.8)g/L(P=0.387),C反应蛋白分别为30.9(10.4~52.1)mg/L和29.5(14.4~58.5)mg/L(P=0.655),血红蛋白分别为(110.0±13.8)g/L和(113.7±13.4)g/L(P=0.187),术后进食时间分别为4(3~5)d和4(3~5)d(P=0.752),术后住院时间分别为13(10~19)d和13(11~18)d(P=1.000),差异均无统计学意义。ICUD组和ECUD组术后病理检查结果显示,T_(a)/T_(1)/Tis期分别为17例(45.9%)和19例(32.8%),T_(2)期分别为12例(32.4%)和18例(31.0%),T_(3)期分别为5例(13.5%)和19例(32.8%),T_(4)期分别为3例(Objective To compare the perioperative complications and prognosis of intracorporeal and extracorporea lileal conduit urinary diversion(ICUD or ECUD)following robot-assisted radical cystectomy(RARC).Methods The data of 95 patients who underwent RARC treatment in Nanjing Drum Tower Hospital from March 2016 to June 2019 were retrospectively analyzed.Among them,37 underwent ICUD and 58 underwent ECUD.In the ICUD group,there were 32 males and 5 females,aged(68.0±7.8)years,body mass index(BMI)of(24.1±3.4)kg/m^(2),American Society of Anesthesiologists(ASA)score of 1-2 in 4 cases(10.8%),ASA score of 3-5 in 33 cases(89.2%),preoperative hemoglobin of(126.5±14.2)g/L,albumin of(39.0±2.2)g/L,and C-reactive protein of 4.0(2.0-8.5)mg/L.In the ECUD group,there were 53 males and 5 females,aged(67.5±9.0)years,BMI of(24.2±3.6)kg/m^(2),ASA score of 1-2 in 16 cases(27.6%),ASA score of 3-5 in 42 cases(72.4%),preoperative hemoglobin of(129.0±12.4)g/L,albumin(38.2±3.1)g/L,and C-reactive protein of 4.9(3.1-14.4)mg/L.There was no significant difference in preoperative data between the two groups(P>0.05).The two groups underwent RARC and pelvic lymph node dissection similarly.The ICUD group underwent a total intracorporeal ileal conduit and the ECUD group underwent extracorporeal ileal conduit with direct vision through a median incision in the lower abdomen.There were 32 cases(86.5%)and 46 cases(79.3%)undergoing expanded pelvic lymph node dissection in the ICUD group and the ECUD group respectively,and the difference was not statistically significant(P=0.374).The complications were graded according to the Clavien-Dindo grading system.The perioperative complications and prognosis of the two groups were compared.Results The operation time of the ICUD group and the ECUD group were(430±63)min vs.(410±69)min,respectively(P=0.163).The estimated blood loss were(435±233)ml vs.(388±277)ml,respectively(P=0.182).Intraoperative blood transfusion were 10 cases(27.0%)and 12 cases(20.7%)(P=0.475).None of the above differences were statistic

关 键 词：膀胱肿瘤 根治性膀胱切除术 机器人辅助 回肠通道术 体内尿流改道 并发症 

分 类 号：R737.14[医药卫生—肿瘤]