膀胱全切原位尿流改道术后并发症分析及生活质量评估

发布时间：2018-08-25 12:28

【摘要】：[目的]对接受膀胱全切原位尿流改道术的病人,进行术后近期和远期并发症统计分析,并使用FACT-BL量表评估患者生活质量,为进一步研究原位尿流改道术提供依据。[方法]本研究回顾性分析昆明医科大学第二附属医院泌尿外科2014年1月至2016年11月以来68例因膀胱癌行膀胱全切原位尿流改道术患者的术后并发症发生情况,并使用FACT-BL量表评估患者生活质量。[结果]全部68例患者接受膀胱全切原位尿流改道术,并全部获得长期随访。患者年龄39-79岁,平均年龄60.34±9.43岁。患者手术顺利完成,术后恢复良好,均康复出院。在完成随访的68例患者中,出现早期并发症10例(14.71%),出现晚期并发症 11 例(17. 64%);术前术后血清 Cr 对比(t=1.305, P=0.196),BUN 对比(t=0.358,P=0.764),二者差别均无统计学意义;术前术后K+对比(t=1.347,P=0.169),Na+对比(t=-1.748, P=0.144), Ca+对比(t=1.097, P=0.319 ),差别均无统计学意义;C1-对比(t=-4.701,P=0.000),差别具有统计学意义;通过加强排尿功能训练,随访1年,白天可控排尿56例(93. 33%),20例出现夜间尿失禁(33. 33%);术后6个月,新膀胱容量(365.02±45.11)ml,最大尿流率(14.36±1.41)ml/s,残余尿量(26.01±8. 10) ml;术后随访 12 个月,FACT-BL 总分 124. 8± 13. 4。[结论]经过1年的随访,原位新膀胱患者术后早期及晚期并发症均在可接受的范围内,白天与夜间的控尿率均可达到日常生活的要求,水电解质平衡紊乱情况较少,上尿路功能恢复良好,新膀胱较接近生理状态的储尿、排尿功能。原位新膀胱术既保存了身体外观上的完整性,又接近于正常膀胱生理特性,明显地提高患者的术后生活质量,患者易于接受,是一种比较理想的手术方式。
[Abstract]:[objective] to evaluate the quality of life (QOL) of patients undergoing total cystectomy and in situ urethral diversion with FACT-BL scale, and to provide a basis for further study of in situ urethral diversion. [methods] from January 2014 to November 2016, 68 patients with bladder cancer undergoing total cystectomy and in-situ urinary diversion were analyzed retrospectively. The quality of life (QOL) was evaluated with FACT-BL scale. [results] all 68 patients underwent total cystectomy and in situ urethral diversion, and all received long-term follow-up. The average age of the patients was 60.34 卤9.43 years. All patients recovered and were discharged from hospital. Of the 68 patients, 10 (14. 71%) had early complications and 11 (17. 7%) had late complications. There was no significant difference in serum Cr before and after operation (t = 1.305, P = 0.196) and bun (t = 0.358, P ~ (0.764), but there was no significant difference in preoperative and postoperative K (t ~ (1.347) P ~ (0.169) and Na (t ~ (1) -1.748, P ~ (0.144), Ca) (t ~ (1.097, P ~ (0.319), there was no significant difference (t ~ (-4.701) P ~ (0.000). 56 cases (93. 3%) of controlled urination during the day were followed up for 1 year by strengthening the training of urination function. The incidence of nocturnal urinary incontinence was 33% (20 / 20). At 6 months after operation, the maximal urinary flow rate of ml, was (365.02 卤45.11) ml, (14.36 卤1.41) ml/s, residual urine volume (26.01 卤8). 10) the total FACT-BL score of 12 months after ml; operation was 124. 8 卤13. 4. [conclusion] after one year's follow-up, the early and late complications of patients with neobladder in situ were within the acceptable range, the urinary control rate during the day and at night could meet the requirements of daily life, and the disturbance of water and electrolyte balance was less. The upper urinary tract function recovered well, the new bladder was close to the physiological state of urine storage and urination function. New bladder surgery in situ not only preserves the integrity of the body appearance, but also approaches the normal bladder physiological characteristics. It obviously improves the quality of life of the patients after operation and is easily accepted by the patients. It is an ideal operation method.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.14

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