全膀胱切除加回肠膀胱术中保留腹膜完整性的临床意义

目的：探讨肌层浸润性膀胱癌行根治性膀胱切除加回肠膀胱术保留腹膜完整性，对患者术后库痛、胃肠功能恢复和肠梗阻等并发症的发生率的影响。方法：行根治性膀胱切除回肠膀胱术中，根据腹膜破损及修复情况设计为腹膜完整组和腹膜非完整组，其中腹膜完整组30例，腹膜非完整组37例；比较两组平均手术时间、出血量、术后库痛时间、镇痛剂应用时间、保留胃管时间、排便时间、肠道功能恢复时间、住院时间及肠梗阻等并发症发生率等参数。结果：两组平均手术时间、出血量差异无统计学意义（P〉0．05），术后鹰痛时间、镇痛药物使用时间、保留胃管时间、排便时间、胃肠功能恢复、住院时间及肠梗阻（3．3％，22．0％）等并发症发生率差异有统计学意义（P〈0．05）。结论：根治性膀胱切除回肠膀胱术保留腹膜完整性不影响手术时间和出血量，可以减轻术后库痛、有利于术后肠道恢复及降低肠梗阻发生率，缩短住院时间。

Clinical significance of peritoneal integrity reserving in radical cystectomy and ileal conduit

To investigate the impact of peritoneal integrity retaining in the surgery of radical cystectomy and ileal conduit, on the postoperative pain, recovery of gastrointestinal function and the incidence of intestinal obstruction and other complications. Method：According to the breakage of the peritoneal in the opration, 67 cases were divided into two goups., the peritoneal complete group（30 cases） and peritoneal non-intact group（37 cases）. The significant markers and therapeutic results were recorded and analyzed, which includes mean operative time, intraoperative blood loss, postoperative pain, analgesics requirement, use of gastric tube, defecation, recovery of intestinal function, length of stay and the incidence of intestinal obstruction and other complication rate. Result： There was no significant difference in the mean operation time, intraoperative blood loss between two groups （P〉0.05）. The peritoneal complete group showed statistically significant better results on postoperative pain, analgesics requirement, the use of gastric tube, defecation, recovery of intestinal function, length of stay and the incidence of intestinal obstruction（3.3%, 22.0%） and other complicatiorts （ P 〈0.05）. Conclusion： Radical cystectomy and ileal conduit with keeping the integrity of the peritoneal does not affect the mean operation time, intraoperative blood loss. It has the advantages of less postoperative pain, shorter recovery of intestinal function, less incidence of intestinal obstruction and shorter length of stay.