原位回肠新膀胱术与Bricker回肠膀胱术临床疗效对比研究
发布时间：2019-05-23 23:44
【摘要】：目的：探讨膀胱癌患者行改良根治性膀胱切除原位回肠新膀胱术与根治性膀胱切除Bricker回肠膀胱术的临床疗效，为膀胱癌患者选择更好的尿流改道方式提供临床参考。方法：选择行改良根治性膀胱切除原位回肠新膀胱术（24例）与根治性膀胱切除Bricker回肠膀胱术（16例）的膀胱癌患者为研究对象。对两组不同尿流改道方式患者的年龄、伴随疾病、肿瘤临床分期及病理分级、淋巴结阳性率、手术时间、术中出血量、住院时间、术后并发症、围手术期死亡率及再手术率、肿瘤复发率、生存率等方面进行比较分析；患者术后1年通过复查方式进行随访，采用膀胱癌特异性量表（FACT-BL）对两组患者健康生活质量进行评分,对评分结果进行比较分析。结果：原位回肠新膀胱术组与Bricker回肠膀胱术组患者在年龄、伴随疾病、肿瘤临床分期及病理分级、围手术期死亡率及再手术率、淋巴结阳性率方面比较无统计学差异(P0.05）。原位回肠新膀胱术组与Bricker回肠膀胱术组患者在手术时间(391.04±62.78min vs314.38±43.5min）、术中出血量(1110.42±59.46ml vs871.87±246.85ml）、住院时间(34.13±6.12d vs28.43±5.80d）方面比较，差异有统计学意义（P0.05)。原位回肠新膀胱术组患者与Bricker回肠膀胱术组患者的尿路感染发生率比较（8.33%vs37.5%)，差异有统计学意义(P0.05)。原位回肠新膀胱术组患者与Bricker回肠膀胱术组患者在不全性肠梗阻发生率（8.33%vs37.5%）、肺部感染率（4.17%vs0%）、切口裂开率（4.17%vs0%）、漏尿率（12.5%vs6.25%）、出口梗阻率（8.33%vs6.5%）方面比较，差异无统计学意义（P0.05)。原位回肠新膀胱术组患者与Bricker回肠膀胱术组患者在1年肿瘤复发率（0%vs0%)和1年生存率（100%vs100%）比较无差异，，两组在3年肿瘤复发率（0%vs6.25%）和生存率（95.583%vs93.75%）比较，差异无统计学意义（P0.05)。应用FACT-BL量表对患者术后1年健康生活质量进行评分，原位回肠新膀胱术组与Bricker回肠膀胱术组患者在社会/家庭状况(SWB)(21.77±1.20分vs21.3±1.86分）、精神状况(EWB)（20.27±2.14分vs19.5±1.45分）方面评分比较，两组差异无统计学意义（P0.05)。然而在躯体状况（PWB)（22.00±1.98分vs20.57±1.34分）、功能状况(FWB）（21.59±2.15分vs17.64±1.86分）、膀胱癌特异性模块（BSS)（33.77±2.71分vs28.57±2.44分）、一般癌症功能评价系统（FACT-G)（85.64±4.16分vs79.07±3.27分）及膀胱癌特异评价系统（FACT-BL)（119.41±5.59分vs107.64±4.07分)评分方面比较，差异有统计学意义(P0.05)。原位回肠新膀胱术组患者与Bricker回肠膀胱术组患者在喜欢自己的体表情况(95.4%vs28.6%,P0.001)、对性有兴趣(59.0%vs28.6%,P0.05)、有勃起和维持功能（72.7%vs14.2%，P0.001）方面比较，差异有统计学意义（P0.05)。结论：改良根治性膀胱切除原位回肠新膀胱术组患者虽然在手术时间、术中出血量、住院时间方面与根治性膀胱切除Bricker回肠膀胱术比较无优势，但是前组手术方式治疗膀胱癌患者可以取得与后者同样的临床效果。并且改良根治性膀胱切除原位回肠新膀胱术患者术后健康生活质量明显高于根治性膀胱切除Bricker回肠膀胱术组患者,而且前者术中保留性神经血管束，有效的保留患者性功能，提高患者术后生活质量，值得在临床上推广应用。
[Abstract]:Objective: To study the clinical effect of radical cystectomy and radical cystectomy with radical cystectomy in patients with bladder cancer. Methods: The patients with bladder cancer (16 cases) of radical cystectomy and radical cystectomy (16 cases) underwent radical cystectomy and radical cystectomy (16 cases) were selected. The age, the associated disease, the clinical stage of the tumor and the pathological grade, the positive rate of the lymph node, the operative time, the intraoperative blood loss, the hospital stay, the postoperative complications, the perioperative mortality and the reoperation rate and the recurrence rate of the tumor in the two groups of different urine flow diversions. The survival rate and other aspects were compared and analyzed. The follow-up was carried out in 1 year after the operation of the patient, and the health quality of the two groups was assessed by using the bladder cancer specific scale (FACT-BL), and the results of the scores were compared and analyzed. Results: There was no significant difference in the age, the concomitant diseases, the clinical stage of the tumor and the pathological grade, the perioperative mortality and the reoperation rate and the positive rate of the lymph node in the in-situ ileal new-bladder operation group (P0.05). In the in-situ ileal new bladder group, the operative time (391.04-62.78 min vs314.38-43.5 min), the intraoperative blood loss (1110.42, 59.46 ml vs871,87-246.85 ml) and the hospital stay (34.13-6.12 d vs28.43-5.80 d) were statistically significant (P0.05). The incidence of urinary tract infection (8.33% vs.5%) in the patients with the in-situ ileal new bladder group and the Bricker ileal-bladder group was statistically significant (P0.05). In the patients with in-situ ileal new bladder, the incidence of total intestinal obstruction (8.33% vs37.5%), pulmonary infection rate (4.17% vs0%), incision dehiscence rate (4.17% vs0%), leakage rate (12.5% vs6.25%) and outlet obstruction rate (8.33% vs6.5%) were not statistically significant (P0.05). In the in-situ ileal new bladder group, the recurrence rate (0% vs0%) and the 1-year survival rate (100% vs100%) of the patients in the Bricker ileal bladder group were not significantly different in the 1-year tumor recurrence rate (0% vs0%) and the 1-year survival rate (100% vs100%), and no significant difference was found between the two groups in the 3-year tumor recurrence rate (0% vs6.25%) and the survival rate (95.583% vs90.75%) (P0.05). The postoperative 1-year health quality of the patient was scored using the FACT-BL scale, and the in-situ ileal new bladder group was compared with the Bricker ileal bladder group in the social/ family condition (SWB) (21.77-1.20 points vs21.3-1.86), the mental state (EWB) (20.27-2.14 points vs19.5-1.45), There was no significant difference between the two groups (P0.05). However, in the body condition (PWB) (22.00-1.98 points vs20.57-1.34), functional status (FWB) (21.59-2.15 points vs17.64-1.86 points), bladder cancer-specific module (BSS) (33.77-2.71 points vs28.57-2.44 points), The general cancer function evaluation system (FACT-G) (85.64-4.16 sub-vs79.07-3.27) and the bladder cancer-specific evaluation system (FACT-BL) (119.41-5.59 sub-vs107.64-4.07 points) scored a statistically significant difference (P0.05). In the patients with in-situ ileal new bladder, the patients with the Bricker's ileal bladder had an interest in sex (59.0% vs28.6%, P <0.05), with an interest in sex (59.0% vs28.6%, P <0.05), and the difference was statistically significant (P <0.05). Conclusion: The modified radical cystectomy and in-situ ileal new bladder operation group has no advantage in the operation time, the intraoperative blood loss, the hospital stay and the radical cystectomy and the Bricker ileal bladder operation. However, the same clinical effect as the latter can be obtained in the treatment of bladder cancer by the operation of the previous group. and the improved radical cystectomy in-situ ileal new cystectomy patient has a significantly higher quality of life after operation than the radical cystectomy Bricker ileal bladder, and the former retains the neurovascular bundle, effectively retains the patient's sexual function, and improves the quality of life of the patient after surgery, And is worthy of being popularized and applied clinically.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14
本文编号：2484346
[Abstract]:Objective: To study the clinical effect of radical cystectomy and radical cystectomy with radical cystectomy in patients with bladder cancer. Methods: The patients with bladder cancer (16 cases) of radical cystectomy and radical cystectomy (16 cases) underwent radical cystectomy and radical cystectomy (16 cases) were selected. The age, the associated disease, the clinical stage of the tumor and the pathological grade, the positive rate of the lymph node, the operative time, the intraoperative blood loss, the hospital stay, the postoperative complications, the perioperative mortality and the reoperation rate and the recurrence rate of the tumor in the two groups of different urine flow diversions. The survival rate and other aspects were compared and analyzed. The follow-up was carried out in 1 year after the operation of the patient, and the health quality of the two groups was assessed by using the bladder cancer specific scale (FACT-BL), and the results of the scores were compared and analyzed. Results: There was no significant difference in the age, the concomitant diseases, the clinical stage of the tumor and the pathological grade, the perioperative mortality and the reoperation rate and the positive rate of the lymph node in the in-situ ileal new-bladder operation group (P0.05). In the in-situ ileal new bladder group, the operative time (391.04-62.78 min vs314.38-43.5 min), the intraoperative blood loss (1110.42, 59.46 ml vs871,87-246.85 ml) and the hospital stay (34.13-6.12 d vs28.43-5.80 d) were statistically significant (P0.05). The incidence of urinary tract infection (8.33% vs.5%) in the patients with the in-situ ileal new bladder group and the Bricker ileal-bladder group was statistically significant (P0.05). In the patients with in-situ ileal new bladder, the incidence of total intestinal obstruction (8.33% vs37.5%), pulmonary infection rate (4.17% vs0%), incision dehiscence rate (4.17% vs0%), leakage rate (12.5% vs6.25%) and outlet obstruction rate (8.33% vs6.5%) were not statistically significant (P0.05). In the in-situ ileal new bladder group, the recurrence rate (0% vs0%) and the 1-year survival rate (100% vs100%) of the patients in the Bricker ileal bladder group were not significantly different in the 1-year tumor recurrence rate (0% vs0%) and the 1-year survival rate (100% vs100%), and no significant difference was found between the two groups in the 3-year tumor recurrence rate (0% vs6.25%) and the survival rate (95.583% vs90.75%) (P0.05). The postoperative 1-year health quality of the patient was scored using the FACT-BL scale, and the in-situ ileal new bladder group was compared with the Bricker ileal bladder group in the social/ family condition (SWB) (21.77-1.20 points vs21.3-1.86), the mental state (EWB) (20.27-2.14 points vs19.5-1.45), There was no significant difference between the two groups (P0.05). However, in the body condition (PWB) (22.00-1.98 points vs20.57-1.34), functional status (FWB) (21.59-2.15 points vs17.64-1.86 points), bladder cancer-specific module (BSS) (33.77-2.71 points vs28.57-2.44 points), The general cancer function evaluation system (FACT-G) (85.64-4.16 sub-vs79.07-3.27) and the bladder cancer-specific evaluation system (FACT-BL) (119.41-5.59 sub-vs107.64-4.07 points) scored a statistically significant difference (P0.05). In the patients with in-situ ileal new bladder, the patients with the Bricker's ileal bladder had an interest in sex (59.0% vs28.6%, P <0.05), with an interest in sex (59.0% vs28.6%, P <0.05), and the difference was statistically significant (P <0.05). Conclusion: The modified radical cystectomy and in-situ ileal new bladder operation group has no advantage in the operation time, the intraoperative blood loss, the hospital stay and the radical cystectomy and the Bricker ileal bladder operation. However, the same clinical effect as the latter can be obtained in the treatment of bladder cancer by the operation of the previous group. and the improved radical cystectomy in-situ ileal new cystectomy patient has a significantly higher quality of life after operation than the radical cystectomy Bricker ileal bladder, and the former retains the neurovascular bundle, effectively retains the patient's sexual function, and improves the quality of life of the patient after surgery, And is worthy of being popularized and applied clinically.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14
【参考文献】
相关期刊论文 前2条
1 韩苏军;张思维;陈万青;李长岭;;中国膀胱癌发病现状及流行趋势分析[J];癌症进展;2013年01期
2 周芳坚;刘卓炜;余绍龙;韩辉;秦自科;李永红;王欢;;改良全膀胱切除原位新膀胱术96例报告[J];中华泌尿外科杂志;2006年08期
本文编号：2484346
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