腹腔镜根治性膀胱癌切除术后行回肠膀胱术和输尿管皮肤造口术的疗效比较

摘要

目的 比较腹腔镜根治性膀胱癌切除术后行回肠膀胱术和输尿管皮肤造口术的疗效.方法 选择行腹腔镜根治性膀胱癌切除术后患者90例,随机分为A组和B组,均45例.A组采取回肠膀胱术,B组采取输尿管皮肤造口术.比较2组手术时间、术中出血量以及术后住院时间、术后并发症、术后生存质量.观察2组患者的胃肠道功能恢复情况.结果 B组患者的手术时间、术中出血量及术后住院时间均明显低于A组(P＜0.01).2组术后尿路感染和肺感染的发生率差异无统计学意义(P＞0.05),B组的切口感染、肠梗阻发生率均明显低于A组,而漏尿发生率明显高于A组(P＜0.05).2组患者术后生理状况、社会/家庭状况、情感状况、功能状况评分比较无统计学差异(P＞0.05).B组胃肠功能恢复的优良率为44.44％,显著高于A组22.22％,差异有统计学意义(x2 =4.05,P＜0.05).结论 膀胱癌切除术后回肠膀胱术和输尿管皮肤造口术各有优、缺点,可根据患者个体情况选择合适的手术方式.%Objective To compare efficacy of ileal conduit and cutaneous ureterostomy following laparoscopic radical cystectomy for bladder carcinoma.Methods 90 patients following laparoscopic radical cystectomy were randomly divided into group A and group B,each with 45 cases.Group A was treated with ileal conduit,group B was given cutaneous ureterostomy.Operation time,amount of bleeding during operation,hospital stays,complication after operation,and suvival quality were compared between the 2 groups.Gastroenteric function recovery was analyzed in both groups.Results Operation time,amount of bleeding during operation,hospital stays of group B were lower than group A (P ＜ 0.01).The incidence rate of urinary tract infection and lung infection after operation had no statistical difference between the 2 groups (P ＞ 0.05).The incidence rate of infection of incisional wound,intestinal obstruction,and in group B was obviously lower,while leakage of urine was more,than group A (P ＜0.05).Scores of physiology condition,society/family condition,emotion condition,and function condition had no statistical difference between the 2 groups (P ＞ 0.05).Excellent and good rate of gastroenteric function recovery of group B was 44.44％,which was higher than that of group A,22.22％,with statistical difference (x2 =4.05,P ＜ 0.05).Conclusion Ileal conduit and cutaneous ureterostomy following laparoscopic radical cystectomy have their own advantages,and we should select corresponding operation by referring to the patients' condition.