膀胱癌根治性全膀胱切除术后行不同尿流改道术对患者生活质量的影响

目的:分析膀胱癌根治性全膀胱切除术后行不同尿流改道术对患者生活质量的影响。方法:选取我院2014年7月至2015年12月期间收治的142例行根治性膀胱全切除及尿道改造术患者的临床资料进行回顾性分析。按照不同改道术将患者分成A组（原位新膀胱术组）（71例，其中原位乙状结肠新膀胱术16例，原位回肠新膀胱术55例）与B组（非原位尿流改道术组）（71例，其中输尿管皮肤造口术10例，回肠通道术61例），治疗结束后记录并比较2组患者近期临床疗效和生活质量。结果:A组手术时间、住院时间均较B组延长（P＜0.05）。B组患者并发症发生率较A组低，但两组患者并发症发生率比较差异无统计学意义（P=0.370）。两组患者术后生活质量比较均存在差异（P＜0.05），其中在生理机能、生理职能、社会功能、精神健康及情感职能5个方面两组患者比较差异具有统计学意义（P＜0.05），且均以A组患者得分较高，而在躯体疼痛、一般健康状况、精力的比较上两组患者差异无统计学意义（P＞0.05）。结论:在根治性膀胱全切除术中采用不同尿流改道术对治疗膀胱癌均具有一定的临床疗效和安全性，但采用原位新膀胱尿流改道的方式更利于提高患者术后生活质量，值得临床上推广使用。

Comparative study of different procedures of urinary diversion on the quality of life of patients with bladder cancer after radical total cystectomy

Objective:To investigate the effect of different procedures of urinary diversion on the quality of life of patients with bladder cancer after radical total cystectomy.Methods:The clinical data of 142 patients who underwent radical cystectomy and reconstruction in our hospital from July 2014 to December 2015 were retrospectively analyzed.According to the different procedures of urinary diversion,the patients were divided into A group (in situ cystectomy group) (71 cases,of which 16 cases were in situ sigmoid colon neocystectomy and 55 cases in situ ileum nestectomy) and B group (non-orthotopic urinary diversion group) (71 cases,of which 10 cases were ureterostomy and 61 cases were ileum).The recent clinical efficacy and quality of life were compared between the two groups after treatment.Results:The time of operation and hospitalization in the A group were longer than those of the B group (P＜0.05).The incidence of complications in the B group was lower than that in the A group,but the difference was not statistically significant (P=0.370).There was significant difference about the postoperative quality of life between the two groups (P＜0.05),of which the physical function,role-physical,social function，role-emotional and mental health in group A were higher than those in the B group(P＜0.05),but there was no statistical significance in somatic pain,general health status,energy between the two groups (P＞0.05).Conclusion:The use of different urinary diversion in radical cystectomy has a certain clinical efficacy and safety for the treatment of bladder cancer,but the new urinary bladder in situ is more beneficial to improve the quality of life after operation,which is worthy of clinical application.