[1]谢巧丽,付 强,张 波,等.腹腔镜下全膀胱切除术后不同尿流改道方式治疗浸润性膀胱癌效果及对患者尿流动力学的影响[J].陕西医学杂志,2021,50(7):829-832.[doi:DOI:10.3969/j.issn.1000-7377.2021.07.015]
　XIE Qiaoli,FU Qiang,ZHANG Bo,et al.Efficacy of different urethral diversion methods in treatment of invasive bladder cancer after laparoscopic radical cystectomy and their influence on urodynamics of patients[J].,2021,50(7):829-832.[doi:DOI:10.3969/j.issn.1000-7377.2021.07.015]
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腹腔镜下全膀胱切除术后不同尿流改道方式治疗浸润性膀胱癌效果及对患者尿流动力学的影响
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
50
期数:
2021年7期
页码:
829-832
栏目:
临床研究
出版日期:
2021-07-05

文章信息/Info

Title:
Efficacy of different urethral diversion methods in treatment of invasive bladder cancer after laparoscopic radical cystectomy and their influence on urodynamics of patients
作者:
谢巧丽; 付 强; 张 波; 王娟英
(空军军医大学唐都医院,西安 710038)
Author(s):
XIE Qiaoli; FU Qiang; ZHANG Bo; WANG Juanying
(Tangdu Hospital,Air Force Medical University,Xi'an 710038,China)
关键词:
腹腔镜下全膀胱切除术;  原位回肠新膀胱重建术;  浸润性膀胱癌;  疗效;  尿流动力学;  回肠新膀胱重建术;  原位乙状结肠新膀胱重建术
Keywords:
Laparoscopic radical cystectomy;  Ileal neobladder reconstruction in situ;  Invasive bladder cancer;  Curative effect;  Urodynamics;  Ileal neobladder reconstruction;  Sigmoid colon neobladder reconstruction in situ
分类号:
R 737.14
DOI:
DOI:10.3969/j.issn.1000-7377.2021.07.015
文献标志码:
A
摘要:
目的:研究了腹腔镜下全膀胱切除术(LRC)后不同尿流改道方式治疗浸润性膀胱癌(IBC)的效果及对患者尿流动力学的影响。 方法:纳入IBC患者114例,根据尿流改道方式的不同分为A组、B组和C组,各38例。A组行回肠新膀胱重建术,B组行原位回肠新膀胱重建术,C组行原位乙状结肠新膀胱重建术。比较三组治疗后的临床指标、生活质量评分和并发症发生率。比较B组和C组治疗后的尿流动力学和控尿能力。结果:A组的手术时间、术中出血量和住院时间均明显低于B组和C组(均P<0.05)。B组的手术时间、术中出血量和住院时间均明显高于C组(P<0.05)。B组的膀胱充盈压、排尿压均明显低于C组(P<0.05),B组的膀胱容量、夜间控尿能力均明显高于C组(P<0.05)。治疗后,B组和C组的生理功能、社会关系和总体健康评分均明显优于A组(均P<0.05)。治疗后,三组的不良反应发生率比较,差异无统计学意义(均P>0.05)。结论:LRC术后回肠原位新膀胱重建术治疗IBC,虽然术式复杂,手术时间长,但患者术后的夜间控尿能力和尿流动力学恢复较好,且对患者的生活质量影响较小,安全性高,可作为IBC患者LRC术后尿道改流的首选方法。
Abstract:
Objective:To study the efficacy of different urethral diversion methods in the treatment of invasive bladder cancer(IBC)after laparoscopic radical cystectomy(LRC)and their influence on the urodynamics of patients.Methods:The 114 IBC patients were divided into group A,group B and group C according to the different urinary diversion,with 38 cases in each group.Group A underwent ileal neobladder reconstruction,and group B underwent ileal neobladder reconstruction in situ,and group C underwent sigmoid colon neobladder reconstruction in situ.The clinical indicators,quality of life score and complication rate after treatment were compared among the three groups.The urodynamics and urinary control ability after treatment were compared between group B and group C.Results:The operation time,intraoperative blood loss and hospitalization time of group A were significantly lower than those of group B and group C(all P<0.05).The operation time,intraoperative blood loss and hospitalization time of group B were significantly higher than those of group C(all P<0.05).The bladder filling pressure and urinary pressure of group B were significantly lower than those of group C,and the bladder capacity and night urine control ability of group B were significantly higher than those of group C(all P<0.05).After treatment,the physiological functions,social relations and overall health scores of group B and group C were significantly better than those of group A(all P<0.05).After treatment,there was no statistically significant difference in the incidence of complications among the three groups(P>0.05).Conclusion:Although the surgical procedure is complicated and the operation time is long,the ileal orthotopic neobladder reconstruction after LRC for IBC has better night-time urinary control and urodynamic recovery after the operation,and it has little impact on the patient's quality of life and is safe,which can be used as the first choice for urethral diversion after LRC in IBC patients.

参考文献/References:

[1] 雷 普.经尿道膀胱肿瘤切除术联合动脉灌注治疗浸润性膀胱肿瘤疗效及对患者生活质量的影响[J].陕西医学杂志,2020,49(1):32-34.
[2] 赵 娜,徐 磊,林宏云,等.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患者免疫功能和生活质量的影响[J].现代生物医学进展,2020,20(3):569-573.
[3] 李文永,李庆文,汪 盛,等.腹腔镜根治性膀胱切除+原位回肠新膀胱术治疗浸润性膀胱癌的临床疗效分析[J].现代肿瘤医学,2017,25(21):3448-3451.
[4] 马 涛.围术期人性化护理对膀胱癌患者治疗依从性及生活质量的影响[J].国际护理学杂志,2016,35(21):2898-2902.
[5] 姚大强,孟德轩.腹腔镜下根治性膀胱全切联合原位回肠新膀胱术治疗膀胱癌临床疗效观察[J].肿瘤基础与临床,2018,31(4):346-348.
[6] 徐宝海,余 义,熊丙健.膀胱癌根治性全膀胱切除术后三种不同尿流改道方式的临床疗效及对患者生活质量的影响[J].解放军医药杂志,2018,30(9):20-23.
[7] 徐航杰,付宜鸣.根治性膀胱切除术后尿流改道方式的比较[J].临床与病理杂志,2018,38(10):2261-2264.
[8] 鲁宏磊,张 志,刘 洋,等.根治性膀胱切除术后回肠与乙状结肠2种原位新膀胱术的临床疗效观察[J].临床泌尿外科杂志,2018,33(1):71-74,78.
[9] 樊俊杰,杨 波,裴昕奇,等.根治性膀胱全切联合体外Studer原位新膀胱术47例临床病理特征及预后分析[J].现代泌尿外科杂志,2020,43(9):1093-1097.
[10] 樊俊杰,杨 波,裴昕奇,等.膀胱全切联合Studer原位新膀胱术后并发症的标准化分析[J].现代泌尿外科杂志,2020,19(8):213-216.
[11] 王大川,王璟琦,许腾飞,等.原位回肠和原位乙状结肠新膀胱术后尿动力学检测和尿控水平对比的Meta分析[J].现代泌尿外科杂志,2019,24(8):654-659.
[12] 王 帅,祁小龙,刘 锋,等.完全腔镜下根治性膀胱切除术及体内原位新膀胱重建术:10年回顾性分析[J].中华泌尿外科杂志,2020,41(11):830-834.
[13] 许 言,肖 峻,陈 昊,等.腹腔镜下根治性全膀胱切除+原位新膀胱术治疗进展[J].临床泌尿外科杂志,2019,34(7):79-82.
[14] 张 涛,于德新,方 露,等.保留神经的腹腔镜根治性膀胱切除原位新膀胱术对性功能和尿控的影响[J].现代泌尿生殖肿瘤杂志,2020,12(2):21-25.
[15] 李 伟,田 良,刘 昊.膀胱癌根治性全膀胱切除术后行不同尿流改道术对患者生活质量的影响[J].现代肿瘤医学,2019,32(9):456-459.
[16] 汪 鑫,朱 猛,任立新,等.完全腹腔镜根治性膀胱切除+ρ形原位回肠新膀胱术的应用研究[J].中华泌尿外科杂志,2019,40(10):747-752.
[17] 宋明泽.根治性膀胱切除术的进展[J].临床外科杂志,2019,27(11):1005-1007.
[18] 周晓菊,周 宏,王安静,等.膀胱全切原位回肠新膀胱与回肠膀胱术对患者生活质量影响的Meta分析[J].国际泌尿系统杂志,2020,40(1):8-13.
[19] 高俊平,王 静,高凯霞,等.胃肠综合训练对老年膀胱癌根治术后患者胃肠功能恢复的影响[J].中华物理医学与康复杂志,2020,42(11):1014-1017.
[20] 汤亚箐,冉 磊,唐 澜.腹腔镜膀胱全切回肠膀胱术治疗浸润性膀胱癌疗效分析[J].实用医院临床杂志,2019,19(4):234-237.

备注/Memo

备注/Memo:
基金项目:陕西省重点研发计划项目(2020SF-124)
更新日期/Last Update: 2021-07-05