不同尿流改道术对膀胱癌根治术后患者生活质量及情绪的影响

摘要

目的 了解尿流改道术对膀胱癌根治术后患者生活质量及情绪的影响.方法 将96例行膀胱癌根治术患者按尿流改道术式分为两组,每组48例.对照组患者给予原位新膀胱术治疗,观察组患者给予回肠膀胱术治疗.于术后1个月、3个月、6个月采用生活质量测量量表评定生活质量,于出院时及术后6个月采用焦虑自评量表、抑郁自评量表评定焦虑抑郁情绪.比较两组术中出血量、胃肠道功能恢复时间及并发症发生情况.结果 术后1个月、3个月、6个月两组患者生活质量测量量表评分持续升高(P<0.01),同期两组间比较差异无统计学意义(P>0.05);术后6个月两组焦虑自评量表、抑郁自评量表评分均较出院时显著降低(P<0.01),同期两组间比较差异无统计学意义(P>0.05).观察组胃肠功能恢复时间显著少于对照组(P<0.01),并发症发生率显著低于对照组(P<0.05).结论 原位新膀胱术与回肠膀胱术对膀胱癌根治术后患者生活质量及情绪的影响不存在明显差异,但后者对机体创伤较小,并发症发生率较低,术后胃肠功能恢复较快,值得临床推广.%Objective To survey the effects of different urinary diversions on quality of life and emotions of patients with bladder cancer after radical operation. Methods Ninety-six bladder cancer patients undergoing radical resection were divided into two groups of 48 ones each according to urinary diversion methods. Control group received orthotopic neobladder and observation did ilealn eobladder. The quality of life was evaluated with the Short Form 36 Health Survey Questionnaire (SF-36) in month 1,3 and 6 after operation and anxious and depressive emotions with the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) at discharge and month 6 after operation. Intraoperative blood loss,recovery time of gastrointestinal function and incidence of complications were compared between two groups. Results The SF-36 scores of both groups continuously heightened in month 1,3 and 6 after operation (P<0.01) and group differences had no statistical significance (P>0.05);in month 6 after operation the SAS and SDS scores of both groups lowered more significantly compared those at discharge (P<0.01) and group differences had no statistical significance (P>0.05). Recovery of gastrointestinal function was quicker (P<0.01) and incidence of complication lower (P<0.05) in observation than in control group. Conclusion The effect of orthotopic neobladder has no obvious difference from ileal neobladder on quality of life and emotions,but the latter has less body trauma,lower incidence of complications,quicker recovery of gastrointestinal function and deserves clinical generalization.