摘要
目的 探析不同尿流改道方式应用于膀胱癌患者机器人辅助腹腔镜(以下简称腹腔镜)下全膀胱切除术后的效果.方法 采用前瞻性研究法,选取 2018 年5 月～2022 年5 月南京大学医学院附属鼓楼医院收治的行腹腔镜下全膀胱切除术的膀胱癌患者 102 例,采用随机数表法分为对照组和试验组两组,各 51 例.对照组行输尿管皮肤造口术,试验组行原位回肠新膀胱重建术.比较两组患者围术期指标、生活质量变化,并统计并发症发生率情况.结果 试验组手术时间及住院时间分别为(372.07±45.48)min、(24.83±4.16)d较对照组(339.47±52.07)min、(21.05±4.72)d长,术中出血量为(857.06±125.39)ml较对照组的(749.14±140.06)ml多,差异有统计学意义(t=3.367、4.291、4.100,P<0.001).试验组治疗后生理功能、心理健康及总体健康评分分别为(64.08±7.25)分、(63.93±7.02)分和(61.17±6.93)分,较对照组的(60.13±6.59)分、(59.97±6.84)分和(57.08±7.11)分高,差异有统计学意义(t=2.879、2.885、2.942,P<0.05);试验组术后尿路感染发生率为 1.96%(1/51),低于对照组的 15.69%(8/51),差异有统计学意义(χ2=4.387,P=0.036).结论 原位回肠新膀胱重建术应用于膀胱癌患者腹腔镜下全膀胱切除术后虽手术时间长,术中出血量多,但可提高生活质量,且术后尿路感染发生率低,安全性更高.
Abstract
Objective To explore the effect of different urinary flow diversion methods in patients with bladder cancer after robot-assisted laparoscopic(hereinafter referred to as laparoscopic)total cystectomy.Methods Using the prospective research method,102 patients with bladder cancer who underwent laparoscopic total cystectomy in our hospital from May 2018 to May 2022 were selected.They were divided into two groups with 51 cases in each group by using the digital random table.Ureterostomy was performed in the control group,and ileal neovesical reconstruction was performed in the experimental group.Perioperative indexes and life quality changes were compared between the two groups,and the incidence of complications was statistically analyzed.Results The surgical time and hospitalization time of the experimental group were(372.07±45.48)minutes and(24.83±4.16)days,respectively,which were longer than those of the control group(339.47±52.07)minutes and(21.05±4.72)days.The intraoperative bleeding volume was(857.06±125.39)ml,which was more than the control group's(749.14±140.06)ml,and the difference was statistically significant(t = 3.367,4.291,4.100,P<0.001);After treatment,the physiological function,mental health,and overall health scores of the experimental group were(64.08±7.25)points,(63.93±7.02)points,and(61.17±6.93)points,respectively,which were higher than the control group's(60.13±6.59)points,(59.97±6.84)points,and(57.08±7.11)points,and the difference was statistically significant(t=2.879,2.885,2.942,P<0.05);The incidence of postoperative urinary tract infections in the experimental group was 1.96%(1/51),lower than the 15.69%(8/51)in the control group(χ2 =4.387,P= 0.036).Conclusion In patients with bladder cancer after laparoscopic total cystectomy,although the operation time is long and the intraoperative bleeding is large,it can improve the quality of life,and the incidence of postoperative urinary tract infection is low,and the safety is higher.
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