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    腹腔镜根治性膀胱全切原位回肠新膀胱与输尿管皮肤造口术后并发症及生活质量评价

    Evaluation of postoperative complications and quality of life in patients treated with ileal orthotopic neo-bladder and cutaneous ureterostomy after laparoscopic radical cystectomy

      摘要
    • 摘要:
      目的评价腹腔镜根治性膀胱切除术（LRC）后原位回肠新膀胱（IN）与输尿管皮肤造口（CU）两种尿流改道方式的近、远期并发症发生率及病人术后生活质量，为尿流改道方式的选择提供参考。
      方法收集行LRC及尿流改道的男性膀胱癌病人61例。根据尿流改道方式不同分为IN组（15例）和CU组（46例）。比较病人近期（3个月内）和远期（3个月后）并发症发生率及生活质量。
      结果IN组手术时间、术后肛门排气时间及术后住院时间明显长于CU组（P < 0.01），IN组病人近期并发症发生率低于CU组（P < 0.01），2组病人远期并发症总发生率差异无统计学意义（P>0.05）。IN组病人术后生活质量评分明显高于CU组（P < 0.01），其中，CU组≥70岁病人生活质量明显高于 < 70岁组（P < 0.01）。
      结论行IN术病人近期并发症发生率低，且术后生活质量高，但对于高龄病人，CU仍为可选择的手术方式。临床中应根据病人的意愿和病情选择合适尿流改道方式，并关注病人的心理影响。

       

      Abstract:
      ObjectiveTo evaluate the early and long-term complications and quality of life in patients treated with ileal orthotopic neo-bladder (IN) or cutaneous ureterostomy (CU) after laparoscopic radical cystectomy (LRC), and provide the clinical basis for selecting urinary diversion.
      MethodsA total of 61 bladder cancer patients treated with LRC combined with urinary diversion were divided into the IN group (15 cases) and CU group (46 cases).The incidence rates of early and long-term complications and quality of life were compared between two groups.
      ResultsThe operation time, anal exhaust time and postoperative hospital stays in IN group were longer than those in CU group (P < 0.01).The incidence rate of early complications in IN group was lower than that in CU group (P < 0.01), however, there was no statistical significance in long-term complications between two groups (P>0.05).The score of quality of life in IN group was significantly higher than that in CU group (P < 0.01), and the quality of life in patients more than 70 years was significantly higher than that in patients less than 70 years in CU group (P < 0.01).
      ConclusionsThe patients treated with IN have low incidence rate of complications and high quality of life.The CU is still an alternative method for elderly patients.the suitable urinary diversion method should be chosed according to patients' demand and disease situation, and the mentality of patients should be considered.

       

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