根治性全膀胱切除加回肠代膀胱术不同手术方式的疗效比较  

Efficacy of different surgical methods for radical cystectomy plus Bricker's ileal conduit urinary diversion

作　　者：洪翔 顾晓露 Hong Xiang;Gu Xiaolu(Department of Urology,Armed Police Marine Police Corps Hospital,Jiaxing 314000,Zhejiang Province,China)

机构地区：[1]武警部队海警总队医院泌尿外科,嘉兴314000

出　　处：《中国基层医药》2022年第1期96-100,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨不同手术方式下根治性全膀胱切除术加回肠代膀胱术临床疗效。方法回顾性收集2010年1月至2020年1月武警部队海警总队医院行根治性全膀胱切除术加回肠代膀胱术患者212例的临床资料,其中腹腔镜手术98例,开放式手术114例。比较两组患者围术期各项临床指标、尿流动力学指标、免疫功能指标、生活质量。结果212例患者手术均成功,期间无转其他方式患者。观察组患者术中出血量、手术时间、术后住院时间均显著低于对照组[(305.89±92.98)mL比(954.76±200.87)mL,(355.76±38.82)min比(411.56±41.13)min,(12.12±2.27)d比(20.47±2.44)d,t=29.33、10.11、25.65,均P<0.001]。观察组膀胱容量、最大尿流率、膀胱内压均显著高于对照组[(300.65±20.52)mL比(245.87±19.78)mL,(16.71±4.32)mL/s比(13.74±2.13)mL/s,(22.65±3.11)cmH_(2)O比(17.74±2.01)cmH_(2)O],残余尿量低于对照组[(20.74±10.03)mL比(50.09±13.96)mL],均差异有统计学意义(t=19.76、6.48、13.83、17.32,均P<0.001)。术后3 d,观察组患者CD_(4)^(+)、CD_(4)^(+)/CD_(8)^(+)水平均高于对照组[(33.18±4.63)%比(30.21±4.91)%,(1.21±0.12)比(1.05±0.11),t=4.508、10.124,均P<0.001],CD_(8)^(+)水平低于对照组[(27.98±3.67)%比(29.47±3.79)%,t=2.90,P=0.004]。术后6,12个月,观察组患者生活质量评分均高于对照组[(101.44±11.52)分比(90.23±15.14)分,(114.72±16.26)分比(101.34±10.56)分,t=5.99、7.20,均P<0.001]。结论膀胱癌患者采用腹腔镜根治性全膀胱切除加回肠代膀胱术具有较高有应用价值,可缩短手术时间,加快患者康复速度,值得大力推广。Objective To investigate the clinical efficacy of different surgical methods for radical cystectomy plus Bricker's ileal conduit urinary diversion.Methods 212 patients,who underwent radical cystectomy plus Bricker's ileal conduit urinary diversion in Armed Police Marine Police Corps Hospital from January 2010 to January 2020,were included in this study.Among them,98 patients underwent laparoscopic surgery,and 114 patients received open surgery.Perioperative clinical indexes,urodynamic indexes,immune function indexes,and quality of life were compared between the two groups.Results All 212 patients succeeded in surgery,and none of them received other surgeries.Intraoperative blood loss[(305.89±92.98)mL vs.(954.76±200.87)mL],operative time[(355.76±38.82)minutes vs.(411.56±41.13)minutes],and length of hospital stay[(12.12±2.27)days vs.(20.47±2.44)days]were significantly lower or shorter in the observation group than in the control group(t=29.33,10.11,25.65,all P<0.001).Bladder volume[(300.65±20.52)mL vs.(245.87±19.78)mL],maximum urinary flow rate[(16.71±4.32)mL/s vs.(13.74±2.13)mL/s],and intravesical pressure[(22.65±3.11)cmH_(2)O vs.(17.74±2.01)cmH_(2)O]were significantly greater in the observation group than in the control group(t=19.76,6.48,13.83,all P<0.001).Residual urine volume was significantly lower in the observation group than in the control group[(20.74±10.03)mL vs.(50.09±13.96)mL,t=17.32,P<0.001].CD_(4)^(+)cell count[(33.18±4.63)%vs.(30.21±4.91)%]and CD_(4)^(+)/CD_(8)^(+) cell count ratio[(1.21±0.12)vs.(1.05±0.11)]measured at 3 days after surgery were significantly higher in the observation group than in the control group(t=4.508,10.124,both P<0.001].CD_(8)^(+) cell count measured at 3 days after surgery was significantly lower in the observation group than in the control group[(27.98±3.67)%vs.(29.47±3.79)%,t=2.90,P=0.004].Scores of quality of life evaluated at 6 months[(101.44±11.52)points vs.(90.23±15.14)points]and 12 months[(114.72±16.26)points vs.(101.34±10.56)points]after surge

关 键 词：膀胱切除术 尿流改道术 腹腔镜检查 膀胱肿瘤 生活质量 免疫 尿流动力学 

分 类 号：R737.14[医药卫生—肿瘤]