王延东,王振兴,许美,徐元高,熊敏,舒芸,石华
WANG Yandong,WANG Zhenxin,XU Mei,XU Yuangao,XIONG Min,SHU Yun,SHI Hua

• 1:贵州医科大学附属人民医院泌尿外科
• 2:贵州医科大学附属人民医院
• 3:贵州医科大学基础医学院
• 4:贵州医科大学附属人民医院手术室

摘要(Abstract)：

目的:比较腹腔镜根治性膀胱切除术(LRC)与开放性根治性膀胱切除术(ORC)治疗肌层浸润性膀胱癌(MIBC)的围手术期临床效果。方法:52例MIBC患者分为LRC组及ORC组,分别接受LRC和ORC治疗,观察手术时间、术中出血量、输血患者数量、术中输液量、血气分析、尿流改道类型、病例分期、术后肛门排气时间、恢复进食时间、住院时间,检测手术前后红细胞压积与肌酐水平,观察并发症发生情况。结果:LRC组接受输血的患者人数、术中总液体入量显著少于ORC组(P<0.05),术后肛门排气时间和恢复进食时间及住院时间显著短于ORC组(P<0.05),术后并发症发生率显著低于ORC组(P<0.05);两组术中血气分析结果均在正常范围之内,两组MIBC患者术前、术后及出院前红细胞压积与肌酐比较,差异无统计学意义(P>0.05),两组MIBC患者尿流改道类型和术后病理分期比较,差异无统计学意义(P>0.05)。结论:LRC治疗MIBC较ORC具有出血少、输血及输液量少、术后肠道功能恢复快、并发症发生率低、住院时间短等优点。
Objective:To compare the perioperative clinical effects of laparoscopic radical cystectomy(LRC) and open radical cystectomy(ORC) in the treatment of myometrial invasive bladder cancer(MIBC).Methods:52 patients with MIBC were divided into LRC group and ORC group,and were treated with LRC and ORC respectively to observe the operation time,the amount of intraoperative blood loss,the number of patients to be transfused,the amount of transfusion during the operation,the blood gas analysis,the type of urinary diversion,the case stage,the time after the operation of the anus,the time of recovery and the time of hospitalization.The level of Hematocrit and myocardiac was detected before and after operation,and the occurrence of complications was observed.Results:The number of patients receiving blood transfusion in LRC group was significantly lower than that in ORC group(P<0.05).The postoperative anal exsufflation time,recovery eating time and hospitalization time were significantly shorter than those in ORC group(P<0.05).The incidence of postoperative complications was significantly lower than that in ORC group(P<0.05).The results of intraoperative blood gas analysis in the two groups were within the normal range,and there was no significant difference in hematocrit and creatine between the two groups before,after and before discharge of MIBC(P>0.05).There was no significant difference in urinary flow diversion type and postoperative pathological stage between the two groups(P>0.05).Conclusion:Compared with ORC,LRC has the advantages of less bleeding,less blood transfusion and infusion,faster recovery of intestinal function after operation,low incidence of complications and short hospitalization time.

关键词(KeyWords)： 膀胱癌;肌层浸润;根治性膀胱切除术;腹腔镜;术后并发症
carcinoma of urinary bladde;muscle layer infiltration;radical cystectomy;peritoneoscope;postoperative complications

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王延东,王振兴,许美,徐元高,熊敏,舒芸,石华
WANG Yandong,WANG Zhenxin,XU Mei,XU Yuangao,XIONG Min,SHU Yun,SHI Hua

DOI: 10.19367/j.cnki.1000-2707.2019.07.022

参考文献(References)：

• [1]MILOWSKY M I,RUMBLE R B,BOOTH C M,et al.Guideline on muscle-invasive and metastatic bladder cancer(european association of urology guideline):american society of clinical oncology clinical practice guideline endorsement[J]. Journal of Clinical Oncology,2016,34(16):1945.
• [2]符伟军,史建国,蔡伟,等.腹腔镜下侵袭性膀胱癌盆腔淋巴结清扫的应用解剖及手术技巧[J].中华泌尿外科杂志,2014,35(2):102-106.
• [3]BOCHNER B H,DALBAGNI G,SJOBERG D D,et al.Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy:a randomized clinical trial[J]. European Urology,2015,194(5):1232-1233.
• [4] HUANG J,LIN T,LIU H,et al. Laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer:oncologic results of 171 cases with a median 3-year follow-up[J]. European Urology,2010,58(3):442-449.
• [5]PAREKH D J,MESSER J,FITZGERALD J,et al. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy[J]. Journal of Urology,2013,189(2):474-479.
• [6]黄健,许可慰,黄海,等.腹腔镜女性膀胱癌根治性切除-原位回肠新膀胱术初步报告[J].中国微创外科杂志,2008,8(4):292-294.
• [7]SUGIHARA T,YASUNAGA H,HORIGUCHI H,et al.Factors affecting choice between ureterostomy,ileal conduit and continent reservoir after radical cystectomy:japanese series[J]. International Journal of Clinical Oncology,2014,19(6):1098-104.
• [8]WITJES J A,COMPéRAT E,COWAN N C,et al. EAU guidelines on muscle-invasive and metastatic bladder cancer:summary of the 2013 guidelines[J]. European Urology,2014,65(4):778-782.
• [9] KISS B,BURKHARD F C,THALMANN G N. Open radical cystectomy:still the gold standard for muscle invasive bladder cancer[J]. World Journal of Urology,2015,34(1):33-39.
• [10]GONDO T,OHNO Y,NAKASHIMA J,et al. Factors predicting incisional surgical site infection in patients undergoing open radical cystectomy for bladder cancer[J].International Journal of Clinical Oncology, 2014, 19(5):935-939.
• [11]WANG S Z,CHEN L W,LIN H Y. Factors associated with increased blood loss in patients undergoing radical cystectomy in a contemporary series[J]. Chinese Journal of Surgery,2012,50(6):831-834.
• [12]YASUI T,TOZAWA K,ANDO R,et al. Laparoscopic versus open radical cystectomy for patients older than 75years:a single-center comparative analysis[J]. Asian Pacific Journal of Cancer Prevention Apjcp,2015,16(15):6353-6357.
• [13]ABOUMARZOUK O M,DREWA T,OLEJNICZAK P,et al. Laparoscopic versus open radical cystectomy for muscle-invasive bladder cancer:a single institute comparative analysis[J]. Urologia Internationalis,2013,91(1):109-112.

文章评论(Comment)：