Effects of two types of urinary diversion on complications and prognosis of patients with laparoscopic radical resection of bladder cancer
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摘要:目的
探讨2种尿流改道术对腹腔镜膀胱癌根治术患者并发症及预后的影响。
方法回顾性分析腹腔镜膀胱癌根治术患者资料, 按尿流改道术式不同分为回肠膀胱术组61例和输尿管皮肤造口术组43例。比较2组患者围术期指标、并发症发生率、生活质量及术后2年复发、死亡情况。
结果2组患者性别、年龄、病理类型、肿瘤数量、临床分期、淋巴结转移情况等一般资料比较，差异无统计学意义(P>0.05); 回肠膀胱术组手术时间、术中出血量、术后肠道功能恢复时间长于或多于输尿管皮肤造口术组，差异有统计学意义(P < 0.05), 2组术后住院时间比较，差异无统计学意义(P>0.05); 2组并发症总发生率分别为27.87%和30.23%, 差异无统计学意义(P>0.05), 各项早期和远期并发症发生率差异无统计学意义(P>0.05)。术后6个月, 2组患者各项生活质量评分差异无统计学意义(P>0.05); 2组患者总生存期、无病生存期、1年复发率、2年总复发率以及病死率差异无统计学意义(P>0.05)。
结论输尿管皮肤造口术较回肠膀胱术手术时间较短、术中出血量较小，对胃肠功能影响较小，但2种术式并发症、生活质量以及预后情况相近，因此临床需根据患者健康状况和自身意愿选择合适的尿流改道术。
Abstract:ObjectiveTo explore the effects of two types of urinary diversion on complications and prognosis of patients with laparoscopic radical resection of bladder cancer.
MethodsThe materials of patients with laparoscopic radical resection of bladder cancer were retrospectively analyzed, and they were divided into ileal conduit surgery group (n=61) and cutaneous ureterostomy group (n=43) according to different types of urinary diversion. The perioperative indicators, incidence of complications, quality of life, and situations of recurrence and death at 2 years after surgery were compared between the two groups.
ResultsThere were no significant differences in general materials such as gender, age, pathological types, number of tumors, clinical staging and lymph mode metastasis between the two groups (P>0.05); the operation time, intraoperative bleeding volume and postoperative recovery time of intestinal function in the ileal conduit surgery group were significantly longer or more than those in the cutaneous ureterostomy group (P < 0.05), but there was no significant difference in postoperative hospital stay between the two groups (P>0.05); there was no significant difference in total incidence rate of complications between two groups(27.87% versus 30.23%, P>0.05), and there were also no significant differences in the incidence rates of various early complications and long-term complications between the two groups (P>0.05). At 6 months after surgery, there was no significant difference in the score of each item of quality of life between the two groups (P>0.05); there were no significant differences in total survival, disease-free survival, 1-year recurrence rate, 2-year total recurrence rate and mortality rate between the two groups (P>0.05).
ConclusionCompared with ileal conduit surgery, cutaneous ureterostomy has shorter operation time, less intraoperative bleeding volume and less effect on gastrointestinal function, but the complications, quality of life and prognosis are similar between the two operation methods, so it is necessary to choose the appropriate urinary diversion according to the health status of patients and their own wishes in clinical practice.
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表 1 2组一般资料比较(x±s)[n(%)]
一般资料 分类 回肠膀胱术组(n=61) 输尿管皮肤造口术组(n=43) 性别 男 54(88.52) 35(81.40) 女 7(11.48) 8(18.60) 年龄/岁 58.74±8.61 59.49±7.97 病理类型 膀胱尿路上皮癌 47(77.05) 34(79.07) 膀胱鳞癌 5(8.20) 3(6.98) 膀胱腺癌 9(14.75) 6(13.95) 肿瘤数量 1个 36(59.02) 20(46.51) ≥2个 25(40.98) 23(53.49) 临床分期 Ⅱ期 51(83.61) 37(86.05) Ⅲ期 10(16.39) 6(13.95) 淋巴结转移 7(11.48) 4(9.30) 
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表 2 2组围术期指标比较(x±s)
组别 手术时间/min 术中出血量/mL 术后肠道功能恢复时间/d 术后住院时间/d 回肠膀胱术组(n=61) 357.86±41.19* 269.34±53.72* 4.12±0.34* 14.20±1.75 输尿管皮肤造口术组(n=43) 291.15±45.78 216.54±46.84 3.48±0.37 13.91±2.18 与输尿管皮肤造口术组比较, * P < 0.05。
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表 3 2组并发症发生情况[n(%)]
组别 早期并发症 远期并发症 切口感染 尿漏 肾功能异常 肠梗阻 造口疝 输尿管梗阻 回肠膀胱术组(n=61) 2(3.28) 5(8.20) 1(1.64) 5(8.20) 2(3.28) 3(4.92) 输尿管皮肤造口术组(n=43) 1(2.33) 3(6.98) 4(9.30) 0 4(9.30) 1(2.33)
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表 4 2组生活质量比较(x±s)
分 组别 生理状况 社会/家庭情况 情感状况 功能状况 回肠膀胱术组(n=61) 22.27±2.59 22.29±2.02 19.08±1.86 20.58±2.76 输尿管皮肤造口术组(n=43) 21.90±2.86 21.53±2.98 19.39±2.15 19.96±3.64
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表 5 2组预后情况比较(x±s)[n(%)]
组别 总生存期/个月 无病生存期/个月 1年复发 2年总复发 2年内死亡 回肠膀胱术组(n=61) 21.95±1.69 20.20±1.94 9(14.75) 14(22.95) 7(11.48) 输尿管皮肤造口术组(n=43) 21.37±1.58 19.81±1.79 6(13.95) 11(25.58) 10(23.26)
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