腹腔镜根治性全膀胱切除+原位回肠新膀胱术对膀胱癌患者的临床疗效及并发症分析

摘 要：目的 比较腹腔镜根治性膀胱全切除+原位回肠新膀胱术与开放手术的临床效果及安全性。方法 选择2010年1月至2015年3月在本院行膀胱全切除+原位回肠新膀胱术的70例患者作为研究对象，其中30例行腹腔镜下手术作为观察组，40例行开放手术作为对照组；对比两组患者围手术期情况、新膀胱功能及并发症发生情况。结果 观察组胃肠道功能恢复时间、术后住院时间明显缩短，术中出血量明显减少，与对照组相比差异具有统计学意义（P＜0.05），手术时间则明显长于对照组（P＜0.05）；两组患者在控尿率、膀胱内压、膀胱容量、剩余尿量等方面差异无统计学意义（P＞0.05），观察组最大尿流率显著高于对照组（P＜0.05）。两组患者术后主要并发症有肠梗阻、尿瘘、尿路感染、肺部感染、排尿困难、切口感染等；观察组总并发症发生率为16.7%，显著低于对照组（37.5%），两组相比差异具有统计学意义（χ2=4.642,P＜0.05）。结论 腹腔镜根治性膀胱全切除+原位回肠新膀胱术具有创伤小、出血少、恢复快、新膀胱功能良好、术后并发生发生率低等优点，值得临床推广。

Clinical efficacy and complications of laparoscopic radical cystectomy with orthotopic ileal neobladderin for treatment of bladder cancer

Objectives To explore the clinical efficacy and safety of laparoscopic radical cystectomy with orthotopic ileal neobladderin in the treatment of patients with bladder cancer.Methods 70 patients underwent radical cystectomy with orthotopic ileal neobladder in our hospital from January 2009 to March 2014 were selected as the research object,including 30 patients underwent laparoscopic operation as the observation group,and 40 patients underwent open operation as control group.Indexes of perioperation period,the new bladder function and total complications were compared in two groups.Results Observation group hospitalization time,recovery time of gastrointestinal function,amount of bleeding in the observation group were less than control group,there was statistically significant difference(P ＜ 0.05).The operation time was significantly longer than that of the control group(P ＜ 0.05).There were no significant differences in urinary continence rate,intravesical pressure,bladder capacity,residual urine volume between two groups (P ＞ 0.05).Total complication rate of observation group(16.7％) was significantly lower than that of control group (37.5％),and there was statistically significant difference between the two groups (x2 =4.642,P ＜ 0.05).Conclusions Laparoscopic radical cystectomy with orthotopic ileal neobladder has the advantages of minima1 trauma,less bleeding,rapid recovery,good bladder function and low complications.It is worth popularizing application in clinical.