全膀胱切除后不同尿流改道法疗效分析

发布时间：2018-10-14 14:03

【摘要】：目的：探讨分析全膀胱切除后原位回肠新膀胱术与回肠膀胱术临床疗效差异方法：学习膀胱癌的诊断和治疗相关文献，回顾分析2008年1月至2012年6月安徽省立医院泌尿外科67例膀胱癌全膀胱切除患者的临床资料，其中行原位回肠新膀胱术35例（新膀胱组,1组），行回肠膀胱术32例（回肠膀胱组，2组）。统计手术中出血量、手术时间、肠道功能恢复时间、住院时间，观察早期并发症，如漏尿、肠梗阻、切口感染、电解质紊乱等。术后每三个月及一年后每半年定期随访复查血常规及生化，泌尿系、盆腔及腹膜后B超。查看肿瘤复发转移、肾积水、继发尿囊结石等晚期并发症情况。数据经SPSS19.0软件进行统计分析，，计量资料（均数±标准差），采用t检验；计数资料使用卡方检验或Fishers精确概率法，以P0.05为差异有统计学意义。结果：原位回肠新膀胱术较回肠膀胱术手术时间久、术中出血多、住院时间长，两种术式的肠道功能恢复时间及早晚期手术并发症差异无统计学意义，原位回肠新膀胱术适应症不如回肠膀胱术广泛，但术后患者可自主控制排尿，术后生活质量高于回肠膀胱术。结论：原位回肠膀胱术与回肠膀胱术各有优点，泌尿外科医生需与病人充分沟通并告知尿流改道的各种手术方式及其优缺点，更适宜的服务于患者。
[Abstract]:Objective: to investigate the difference of clinical efficacy between in situ ileal neobladder and ileal cystectomy after total cystectomy. Methods: to study the literature on the diagnosis and treatment of bladder cancer. From January 2008 to June 2012, the clinical data of 67 patients with total cystectomy of bladder cancer in the Department of Urology, Anhui Provincial Hospital, were retrospectively analyzed. 35 cases were treated with in situ ileal neobladder (group 1) and 32 cases with ileal bladder (group 2). The bleeding volume, operation time, intestinal function recovery time, hospitalization time, early complications such as urine leakage, intestinal obstruction, incision infection, electrolyte disturbance and so on were analyzed. Blood routine and biochemical, urinary, pelvic and retroperitoneal B ultrasound were followed up every three months and one year after operation. Check tumor recurrence and metastasis, hydronephrosis, secondary allantolithiasis and other late complications. The data were statistically analyzed by SPSS19.0 software, the measurement data (mean 卤standard deviation) were measured by t test, and the counting data were calculated by chi-square test or Fishers accurate probability method, with P0.05 as the difference. Results: the in situ ileal neobladder operation was longer than that of ileal bladder operation, with more bleeding and longer hospital stay. There was no significant difference in the recovery time of intestinal function between the two operations. The indication of orthotopic ileal neobladder is not as wide as that of ileal cystectomy, but the postoperative patients can control urination autonomously, and the quality of life after operation is higher than that of ileal cystectomy. Conclusion: in situ ileal cystectomy and ileal cystectomy have respective advantages. Urologists should communicate fully with the patients and inform them of the various surgical methods of urinary diversion and their advantages and disadvantages so as to better serve the patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

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