不同尿流改道术式在膀胱癌患者术中的疗效及生活质量的比较
发布时间：2018-10-10 20:44
【摘要】：目的： 探讨回肠膀胱术、原位回肠新膀胱术、输尿管皮肤造口术等三种不同尿流改道术式在膀胱癌患者手术中的应用、早期并发症及生活质量的差异,为膀胱癌患者尿流改道术式的选择提供临床依据。 方法： 收集2010年1月至2013年6月间在我院接受膀胱癌手术的186例膀胱癌患者,所有患者在全膀胱切除后行尿流改道术,按尿流改道术式分为：回肠膀胱术组(A组,65例),原位新膀胱术组(B组,58例),输尿管皮肤造口术组(C组,63例)。收集并将各组患者的基线资料、术中失血量、手术时间、肠道功能恢复时间、住院时间,记录术后早期并发症,如伤口感染、肺部感染、肠梗阻、漏尿、尿路感染和围手术期死亡人数及其它并发症,采用膀胱癌患者生活质量量表(FACT-BL)评估术后生命质量变化,比较三组间各资料差异,探讨三种不同尿流改道术式在老年膀胱癌患者手术中的应用、早期并发症及术后近期生活质量的差异。 结果： 三组间基线资料比较差异无统计学意义(P0.05),手术时间、术中出血量、肠道功能恢复时间和住院时间的差异具有统计学意义(P0.05)。输尿管皮肤造口术组(C组)在术中出血量、手术时间、肠道功能恢复时间和住院时间上优于回肠膀胱术组(A组)及原位新膀胱术组(B组)(P0.05),回肠膀胱术组(A组)的手术时间、住院时间优于原位新膀胱术组(B组)(P0.05),A组和B组间的术中出血、肠道功能恢复时间的无统计学差异(P0.05)。 三组患者术后近期(6月)并发症如急性肾盂肾炎、急性肠梗阻等其差异具有统计学意义(P0.05),C组的急性肾盂肾炎显著高于A、B两组(P0.05),而急性肠梗阻显著低于A、B两组(P0.05),A、B两组比较无统计学差异(P0.05)。 三组患者术后远期(6月)并发症如肾功能损害、代谢性酸中毒具有统计学意义(P0.05),C组显著高于A、B两组(P0.05),A、B两组无差异(P0.05)。皮肤造口狭窄、储尿囊结石、肿瘤原位复发等三组比较无统计学差异(P0.05)。 三组患者术后六个月后的FACT-BL具有统计学差异(P0.05),原位回肠新膀胱术组(B组)显著优于A、C两组(P0.05),回肠膀胱术组(A组)与输尿管皮肤造口术组(C组)无统计学差异(P0.05)。 结论： (1)原位回肠新膀胱术最显著优点是术后生活质量高于回肠膀胱术及输尿管皮肤造口术患者,但该手术相对复杂、创伤大、住院时间长、医疗费用高,回肠膀胱术次之,但术后功能恢复及生活质量仍不理想。 (2)输尿管皮肤造口术较其它两种术式操作简单、术后恢复快,医疗费用少,但输尿管皮肤造口术患者术后生活质量差,远期并发症高于回肠膀胱术及原位回肠新膀胱术患者。 (3)三种术式均可用于膀胱癌患者根治性膀胱切除术后的尿道改流,临床上应根据患者肿瘤的性质及位置、有无转移、患者的一般情况及个人意愿等作出个体化的选择,以满足术后生活质量不同期望值及不同病情患者。
[Abstract]:Objective: to explore the application of three different ureteral diversion procedures, including ileal bladder operation, in situ ileal neobladder operation and ureteral dermatostomy, in patients with bladder cancer, and the differences in early complications and quality of life. To provide a clinical basis for the choice of urinary diversion in patients with bladder cancer. Methods: from January 2010 to June 2013, 186 patients with bladder cancer underwent bladder cancer surgery in our hospital. All patients underwent urinary diversion after total cystectomy. The patients were divided into three groups: ileal cystectomy group (group A, 65 cases), orthotopic neocystectomy group (group B, 58 cases) and ureterostomy group (group C, 63 cases). The baseline data, intraoperative blood loss, operative time, intestinal function recovery time, hospitalization time, early postoperative complications such as wound infection, pulmonary infection, intestinal obstruction, leakage of urine were collected and recorded. The quality of life (QOL) of urinary tract infection and perioperative mortality and other complications were evaluated by FACT-BL, and the differences among the three groups were compared. To explore the application of three different urinary diversion methods in the elderly patients with bladder cancer, the early complications and the difference of postoperative quality of life. Results: there was no significant difference in baseline data among the three groups (P0.05). The time of operation, the amount of intraoperative bleeding, the time of recovery of intestinal function and the time of hospitalization were statistically significant (P0.05). The operative time of ureteral dermatostomy group (group C) was better than that of ileal cystectomy group (group A) and in situ neocystectomy group (group B) (P0.05) and ileal cystectomy group (group A). The hospitalization time was better than that in the in situ neobladder group (P0.05). There was no significant difference in the recovery time of intestinal function between), A group and B group (P0.05). The immediate postoperative complications in the three groups were acute pyelonephritis, The difference of acute intestinal obstruction was statistically significant (P0.05). The acute pyelonephritis in), C group was significantly higher than that in), C group (P0.05), while acute intestinal obstruction was significantly lower than that in Ameb group (P0.05), and there was no significant difference between the two groups (P0.05). The complications such as renal function damage and metabolic acidosis were significantly higher in), C group than in Agna B group (P0.05), but there was no significant difference between the two groups (P0.05). There was no significant difference among the three groups (P0.05). Six months after operation, the FACT-BL of the three groups was statistically different (P0.05), the in situ ileal neobladder operation group (group B) was significantly better than that of the control group (P0.05), while the ileal cystectomy group (group A) and ureterostomy group (group C) had no statistical difference (P0.05). Conclusion: (1) the most significant advantage of in situ ileal neobladder surgery is that the quality of life after operation is higher than that in patients with ileal cystectomy and ureteral dermatostomy, but the operation is relatively complex, with large trauma, long hospital stay and high medical cost. Ileal cystectomy was the second, but the functional recovery and quality of life were still not satisfactory. (2) the ureteral dermatostomy was easier to operate than the other two methods, the postoperative recovery was faster, and the cost of medical treatment was less. However, the quality of life of patients with ureteral dermatostomy was poor, and the long-term complications were higher than those of patients with ileal cystectomy and in situ ileal neobladder surgery. (3) all three methods could be used for urethral revascularization after radical cystectomy in patients with bladder cancer. The individual choice should be made according to the nature and location of the tumor, the metastasis, the general situation and the personal will of the patients, so as to meet the different expectations of postoperative quality of life and patients with different conditions.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14
本文编号：2263186
[Abstract]:Objective: to explore the application of three different ureteral diversion procedures, including ileal bladder operation, in situ ileal neobladder operation and ureteral dermatostomy, in patients with bladder cancer, and the differences in early complications and quality of life. To provide a clinical basis for the choice of urinary diversion in patients with bladder cancer. Methods: from January 2010 to June 2013, 186 patients with bladder cancer underwent bladder cancer surgery in our hospital. All patients underwent urinary diversion after total cystectomy. The patients were divided into three groups: ileal cystectomy group (group A, 65 cases), orthotopic neocystectomy group (group B, 58 cases) and ureterostomy group (group C, 63 cases). The baseline data, intraoperative blood loss, operative time, intestinal function recovery time, hospitalization time, early postoperative complications such as wound infection, pulmonary infection, intestinal obstruction, leakage of urine were collected and recorded. The quality of life (QOL) of urinary tract infection and perioperative mortality and other complications were evaluated by FACT-BL, and the differences among the three groups were compared. To explore the application of three different urinary diversion methods in the elderly patients with bladder cancer, the early complications and the difference of postoperative quality of life. Results: there was no significant difference in baseline data among the three groups (P0.05). The time of operation, the amount of intraoperative bleeding, the time of recovery of intestinal function and the time of hospitalization were statistically significant (P0.05). The operative time of ureteral dermatostomy group (group C) was better than that of ileal cystectomy group (group A) and in situ neocystectomy group (group B) (P0.05) and ileal cystectomy group (group A). The hospitalization time was better than that in the in situ neobladder group (P0.05). There was no significant difference in the recovery time of intestinal function between), A group and B group (P0.05). The immediate postoperative complications in the three groups were acute pyelonephritis, The difference of acute intestinal obstruction was statistically significant (P0.05). The acute pyelonephritis in), C group was significantly higher than that in), C group (P0.05), while acute intestinal obstruction was significantly lower than that in Ameb group (P0.05), and there was no significant difference between the two groups (P0.05). The complications such as renal function damage and metabolic acidosis were significantly higher in), C group than in Agna B group (P0.05), but there was no significant difference between the two groups (P0.05). There was no significant difference among the three groups (P0.05). Six months after operation, the FACT-BL of the three groups was statistically different (P0.05), the in situ ileal neobladder operation group (group B) was significantly better than that of the control group (P0.05), while the ileal cystectomy group (group A) and ureterostomy group (group C) had no statistical difference (P0.05). Conclusion: (1) the most significant advantage of in situ ileal neobladder surgery is that the quality of life after operation is higher than that in patients with ileal cystectomy and ureteral dermatostomy, but the operation is relatively complex, with large trauma, long hospital stay and high medical cost. Ileal cystectomy was the second, but the functional recovery and quality of life were still not satisfactory. (2) the ureteral dermatostomy was easier to operate than the other two methods, the postoperative recovery was faster, and the cost of medical treatment was less. However, the quality of life of patients with ureteral dermatostomy was poor, and the long-term complications were higher than those of patients with ileal cystectomy and in situ ileal neobladder surgery. (3) all three methods could be used for urethral revascularization after radical cystectomy in patients with bladder cancer. The individual choice should be made according to the nature and location of the tumor, the metastasis, the general situation and the personal will of the patients, so as to meet the different expectations of postoperative quality of life and patients with different conditions.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14
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