腹腔镜下保留女性内生殖器官的膀胱全切术-原位回肠新膀胱术8例疗效评价

目的探讨保留内生殖器的女性膀胱癌根治术的生活质量及肿瘤学预后。方法 2012年1月至2017年12月31例女性膀胱癌患者接受腹腔镜膀胱全切术-原位回肠新膀胱术。8例患者接受保留生殖器官手术(保留生殖器官组),同期23例患者采用标准膀胱癌根治术(传统手术组),术后随访12~72个月。评价两组在手术时间、出血量、并发症、尿控、性生活质量及肿瘤学结果的差异。结果与传统手术组相比,保留女性生殖器官组手术时间更短(353.13±69.95)min vs.(459.35±81.52)min,P=0.003];出血量更少(493.75±80.52)mL vs.(728.70±131.82)mL,P=0.001];术后通气时间更短(3.13±0.99)vs.(4.26±0.86)d,P=0.004]。保留生殖器官组日间尿控及夜间尿控均明显优于传统手术组,女性性功能指数(FSFI)评分显著改善(21.00±2.83)vs.(12.35±2.46),P=0.001]。肿瘤特异性生存率差异无统计学意义(P=0.894)。结论腹腔镜下保留女性内生殖器的膀胱切除术在功能学和并发症发生率方面优于传统手术组,肿瘤学预后无显著差异。

Preservation of the internal genital organs during laparoscopic radical cystectomy-orthotopic neobladder:a report of 8 cases

Objective To explore the patients\quality of life and oncological prognosis after internal genitalia sparing cystectomy for bladder cancer.Methods The 31 patients who underwent orthotopic neobladder after radical cystectomy during Jan.2012 and Dec.2017 were divided into two groups:pelvic organ-preserving group(n=8)and traditional group(n=23).Operation time,blood loss,complications,urinary continence,sexual function and prognosis were analyzed after a follow-up of12-72 months.Results The pelvic organ-preserving group had shorter operation time(353.13±69.95)min vs.(459.35±81.52)min,P=0.003],less blood loss(493.75±80.52)mL vs.(728.70±131.82)mL,P=0.001],shorter time of postoperative food intake(3.13±0.99)d vs.(4.26±0.86)d,P=0.004],better daytime and nighttime continence,and higher female sexual function index(FSFI)(21.00±2.83)vs.(12.35±2.46),P=0.001].There was no difference in cancer-specific survival(CSS)between the two groups(P=0.894).Conclusion Genital sparing cystectomy is advantageous over traditional surgery in preserving female functions and reducing complications with comparable oncological outcomes.