不同尿流改道术对膀胱癌根治术后患者抑郁焦虑状态和血清5-羟色胺、去甲肾上腺素水平的影响

目的:探讨不同尿流改道术对膀胱癌根治术后患者恢复质量、抑郁焦虑状态和血清5-羟色胺（5-hydroxytryptamine，5-HT）、去甲肾上腺素（norepinephrine，NE）水平的影响。方法:选取2018年01月至2020年09月期间在我院收治的拟行膀胱癌根治术的132例患者，根据尿流改道术式分为A组（n=68）和B组（n=64），A组患者给予原位新膀胱术治疗，B组患者给予非原位尿流改道术治疗。比较两组患者基线资料、围手术期情况、术后恢复质量、术后抑郁焦虑情况和血清5-HT、NE水平变化。结果:两组患者的基线资料比较差异无统计学意义（P＞0.05）。与B组相比，A组手术时间、住院时间延长，术后恢复质量更高（P＜0.05）。与术前比较，两组患者出院前24 h、术后3个月的贝克抑郁自评量表（Beck Depression Inventory，BDI）评分、贝克焦虑自评量表(Beck Anxiety Inventory，BAI)评分明显升高，血清5-HT、NE水平明显降低（P＜0.05）。A组患者出院前24 h、术后3个月的BDI评分、BAI评分明显低于B组，血清5-HT、NE水平明显高于B组（P＜0.05）。结论:原位新膀胱术与非原位尿流改道术对膀胱癌根治术后患者抑郁焦虑状态和血清5-HT、NE水平的影响存在明显差异，前者术后恢复质量较高，可缓解术后抑郁焦虑状态，值得临床推广。

Effect of different urinary diversions on depression and anxiety status and serum 5-hydroxytryptamine and norepinephrine levels in patients undergoing radical resection of bladder cancer

Objective:To investigate the effect of different urinary diversions on quality of recovery,depression and anxiety status,serum 5-hydroxytryptamine （5-HT） and norepinephrine （NE） levels in patients undergoing radical resection of bladder cancer.Methods:132 patients undergoing radical resection of bladder cancer were selected from the our hospital from January 2018 to September 2020.They were divided into A group (n=68) and B group (n=64) according to urinary diversion methods.A group received in situ cystectomy and B group did non-orthotopic urinary diversion．The baseline data,perioperative conditions,postoperative quality of recovery,postoperative depression and anxiety,serum 5-HT and NE levels were compared between the two groups.Results:There was no significant difference in baseline data between the two groups （P＞0.05）.Compared with the B group,the time of operation and hospitalization in A group were prolonged,and the postoperative quality of recovery was higher （P＜0.05）.Compared with preoperation,Beck Depression Inventory （BDI） score and Beck Anxiety Inventory (BAI) score in the two groups increased significantly at 24 h before discharge and 3 months postoperatively,and serum 5-HT and NE levels were significantly decreased （P＜0.05）.The BDI score and BAI score in A group were significantly lower than those in B group at 24 h before discharge and 3 months postoperatively,and the serum levels of 5-HT and NE were significantly higher than those in B group （P＜0.05）.Conclusion:The effect of in situ cystectomy has significantly difference from non-orthotopic urinary diversion on depression and anxiety status and serum 5-HT and NE levels in patients undergoing radical resection of bladder cancer，and the former has higher postoperative quality of recovery，can relieve postoperative depression and anxiety status and deserves clinical generalization．