53例腹腔镜下根治性膀胱切除术的临床分析

发布时间：2018-05-26 04:16

本文选题：腹腔镜 + 膀胱癌　；参考：《重庆医学》2017年01期

【摘要】：目的探讨单中心腹腔镜下根治性膀胱切除术治疗膀胱癌安全性及肿瘤控制的效果。方法选择2009年9月至2015年9月本中心所行腹腔镜下根治性膀胱切除、尿流改道术患者53例,收集临床病理资料,并对术后并发症及生存情况进行随访,运用Kaplan-Meier法分析生存数据,得出术后3年的生存率。结果所有手术均成功在腹腔镜下完成,平均手术时间(417±111)min,平均出血量(491±355)mL,输血率34.0%,术后平均住院时间为(21.1±9.6)d。近期并发症发生率37.7%(20/53),远期并发症发生率22.6%(12/53)。本组病理多为尿路上皮癌(88.7%),其中高级别肿瘤占57.1%,浸润性膀胱癌(T2期及以上)占77.4%。平均随访时间(24±19)个月,截至2015年12月,29例(54.7%)无瘤存活,3年总体生存率为57.0%,无复发生存率为72.0%,肿瘤特异性生存率为74.0%,亚组分析显示70岁及以下比70岁以上者总体生存率高,非肌层浸润性比肌层浸润性膀胱癌总体生存率高。结论腹腔镜下根治性膀胱切除术安全有效,中期随访结果显示对肿瘤的控制满意,与开放性手术具有可比性。
[Abstract]:Objective to evaluate the safety and tumor control of single-center laparoscopic radical cystectomy for bladder cancer. Methods from September 2009 to September 2015, 53 patients underwent laparoscopic radical cystectomy and urinary diversion were selected. The clinical and pathological data were collected, and the postoperative complications and survival conditions were followed up. Survival data were analyzed by Kaplan-Meier method. The 3-year survival rate was obtained. Results all the operations were successfully performed under laparoscopy. The mean operation time was 417 卤111 minutes, the mean blood loss was 491 卤355mL, the blood transfusion rate was 34.0 and the average hospital stay was 21.1 卤9.6 days. The incidence of short term complications was 37. 7% 20 / 53 and 22. 6% / 53%. Most of the cases were urethral epithelial carcinoma (88.7%), including 57.1% of high grade tumors and 77.4% of invasive bladder carcinoma at T2 stage and above. The mean follow-up time was 24 卤19 months. As of December 2015, 29 patients (54.74.7a) survived without tumor. The overall 3-year survival rate was 57.0, the recurrence free survival rate was 72.0, and the tumor-specific survival rate was 74.0. The subgroup analysis showed that the overall survival rate of patients aged 70 years and below was higher than that of those over 70 years old. The overall survival rate of non-myometrial invasive bladder cancer was higher than that of myometrial invasive bladder cancer. Conclusion Laparoscopic radical cystectomy is safe and effective. The results of mid-term follow-up show that the control of tumor is satisfactory and comparable with open operation.
【作者单位】：四川省医学科学院/四川省人民医院泌尿外科;
【分类号】：R737.14

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