腹腔镜下膀胱根治性切除术后2种尿流改道术式的近期并发症比较

目的 比较腹腔镜下膀胱根治性切除术(LRC)后2种尿流改道术式的早期并发症.方法 回顾性分析2012年1月至2016年7月安徽医科大学第二附属医院收治的116例行腹腔镜下膀胱根治性切除的膀胱癌患者临床资料,其中76例行腹腔镜下膀胱根治性切除回肠膀胱术作为回肠膀胱组,40例行原位回肠新膀胱术作为新膀胱组.比较两组患者一般情况、术中失血量、手术时间、肠道恢复时间、术后住院时间、术后90 d内返院率及术后早期并发症,根据Clavien-Dindo分级系统分析2种尿流改道方式术后90 d内并发症情况.结果 回肠膀胱组手术时间为(298.86±31.73)min,术后住院时间为(15.34±5.18)d,与新膀胱组相比,差异有统计学意义(P<0.05).两组患者术中失血量、肠道恢复时间、术后90 d内返院率及术后早期并发症发生率的差异无统计学意义(P>0.05),两组患者轻中度、重度并发症发生率的差异无统计学意义(P>0.05).结论 LRC术后两种尿流改道方式术后早期并发症发生率无明显差异,原位回肠新膀胱术能明显提高患者术后的生活质量,是值得推荐的膀胱替代手术方式.

Comparison of early complications in two urinary diversions after laparoscopic radical cystectomy

Objective To compare the early complications of two urinary diversions after laparoscopic radical cystectomy(LRC).Methods We retrospectively analyzed the data of 116 consecutive patients who underwent LRC from Jan.2012 to July.2016 in our hospital.Seventy-six patients who underwent Bricker operation were assigned into Bricker operation group, and 40 patients underwent orthotopic ileal neobladder were recruited into neobladder group.The parameters associated with genneral conditions,amount of bleeding during operation, operative time, recovery time of intestinal function,postoperative hospital stay,readmission rates (90 days after operation)and the early complications were compared between the two groups.Early postoperative complications were recorded and graded according to Clavien-Dindo classification system.Results The time of operation in the Bricker operation group was (298.86±31.73) min, the postoperative hospital stay in the Bricker operation group was (15.34±5.18) d,andthe difference in the time of operation,postoperative hospital stay between two groups were significant(P<0.05).No demonstrable difference in amount of bleeding during operation,recovery time of intestinal function,incidence of early compliacations and readmission rates (90 days after operation) was found between the two groups in our review(P>0.05).And there was no significant difference between two groups in grade Ⅰ~Ⅱ complication rates and Ⅲ~Ⅴcomplication rates(P>0.05).Conclusion There is no significant difference in the incidence of early complications between the two urinary diversions after LRC.Orthotopic ileal neobladder can offer a better quality of life and its application can be advocated when possible for bladder substitution in the patients with bladder carcinoma.