腹腔镜根治性膀胱全切除联合回肠原位新膀胱术对膀胱癌的疗效及尿动力学影响-现代医学

腹腔镜根治性膀胱全切除联合回肠原位新膀胱术对膀胱癌的疗效及尿动力学影响

单位：武汉市第六医院泌尿外科, 湖北武汉 430015

分类号：R737.14

出版年·卷·期（页码）：2017·36·第五期（673-677）

摘要：

目的：探讨腹腔镜根治性膀胱全切除联合回肠原位新膀胱术对膀胱癌的疗效及尿动力学的影响。方法：将70例膀胱癌患者按照手术方法分为开放组（开放手术，31例）和腹腔镜组（腹腔镜手术，39例），记录两组患者的手术时间、术中出血量、胃肠功能恢复时间、住院时间、淋巴结清扫数量及术后并发症发生率。术后3个月检查两组患者的最大尿流率、膀胱容量、充盈期膀胱压力、排尿时最大膀胱压、最大尿道压、残留尿量等尿动力学指标，并记录两组患者术后3、6个月时的控尿率。结果：两组手术时间、淋巴结清扫数量比较，差异无统计学意义（P > 0.05），与开放组比较，腹腔镜组术中出血量显著减少，胃肠功能恢复时间及住院时间显著缩短，差异均有统计学意义（P < 0.05）。两组术后主要并发症有肠梗阻、代谢性酸中毒、新膀胱尿道吻合口狭窄、泌尿系统反复感染、切口疝等，两组各种并发症发生率比较，差异无统计学意义（P > 0.05）。术后随着时间的延长，两组患者的控尿率逐渐增加，且日间控尿率高于夜间；两组术后3、6个月日间和夜间的控尿率比较，差异均无统计学意义（P > 0.05）。术后3个月，两组患者最大尿流率、膀胱容量、充盈期膀胱压力、排尿时最大膀胱压、最大尿道压、残留尿量比较，差异均无统计学意义（P > 0.05）。结论：腹腔镜根治性膀胱全切除联合回肠原位新膀胱术创伤小、出血量少，胃肠功能恢复快，术后控尿率、尿动力学指标与开放手术相近。

Objective: To explore the effects of laparoscopic cystectomy and ileal orthotopic neobladder on clinical efficiency and urodynamics in treatment of bladder cancer.Methods: According to the operation method, 70 cases of bladder cancer were divided into open group(31 cases) and laparoscopic group (39 cases).The operation time, volume of blood loss, gastrointestinal function recovery time, hospital stays, number of lymph node dissection and postoperative complications were recorded.Three months after the operation,the maximum urine flow rate,bladder capacity, filling stage bladder pressure, maximum bladder pressure, maximum urethral pressure, residual urine volume and other indicators of urodynamics and continence rate were all recorded.Results: There was no statistical significance in operation time, lymph node dissection between the two groups after operation (P>0.05). Compared with the open group, the volume of bleeding was significantly reduced in laparoscopic group, gastrointestinal function recovery time, length of hospital stay were significantly reduced, the difference had statistic significance (P<0.05).The major postoperative complications of the two groups were intestinal obstruction, metabolic acidosis, the new bladder urethral anastomotic stenosis, recurrent urinary tract infection, incisional hernia, and the difference of operative complication rate between the two groups had no statistical significance (P>0.05). Postoperative continence rate between the two groups were gradually increased, and the day urinary control rate was higher than the night, there were no significant difference between day and night urinary control rate at 3 months post-operation and 6 months post-operation (all P>0.05).Three months after operation,maximal urinary flow rate,bladder capacity and bladder pressure during filling, micturition maximum bladder pressure,maximum urethral pressure,residual urine volumebetween the two groups had no statistically significant (all P>0.05). Conclusion: Laparoscopic radical resection of bladder resection combined with ileal neobladder has small trauma, less bleeding, faster recovery of gastrointestinal function advantages, the postoperative urinary control, urinary dynamics are similar with open surgery, and worthy of clinical promotion.

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