摘要
目的 评估改良根治性膀胱切除术对低龄膀胱癌患者性生活质量和排尿功能的影响.方法 回顾性选取2020年11月至2023年11月玉林市红十字会医院收治的86例低龄膀胱癌患者作为研究对象.按照治疗方法不同分为改良组(n=46)和对照组(n=40).改良组则在膀胱切除过程中保留一部分前列腺包膜,采用回肠造膀胱技术在原位重建尿流通道.对照组采用腹腔镜下全膀胱根治性切除手术,伴随传统的尿道重建方法.比较两组患者术前和术后3个月的国际勃起功能指数(IIEF)评分、精液参数、膀胱功能指标(膀胱容量、膀胱内压、膀胱残余尿量和最大尿流率)以及近期和远期排尿异常率指标.结果 术后3个月,两组患者的IILE评分均较术前降低,且改良组患者的IIEF评分为(20.01±0.64)分,明显高于对照组[(17.34±3.21)分],差异有统计学意义(P＜0.05).术后3个月,改良组患者的精液量较术前显著下降,差异有统计学意义(P＜0.05),而精子密度、精子活动量、精子活力与治疗前比较,差异均无统计学意义(P＞0.05);对照组患者的精液参数均较术前明显降低,差异均有统计学意义(P＜0.05);改良组患者术后3个月的精液量、精子密度、精子活动量、精子活力分别为(2.81±0.53)mL、(34.32±10.42)× 106/mL、(55.32±13.52)％、(56.24±10.23)％,均明显高于对照组[(1.32±0.34)mL、(20.24±6.74)× 106/mL、(41.32±14.34)％、(41.24±8.35)％],差异均有统计学意义(P＜0.05).改良组患者术后膀胱容量和最大尿流量分别为(454.23±54.55)mL、(18.35±3.54)mL/s,均明显高于对照组[(409.24±48.24)mL、(13.45±3.75)mL/s],膀胱残余尿量为(21.43±5.76)mL,明显低于对照组[(44.42±10.34)mL],差异均有统计学意义(P＜0.05);两组患者的膀胱内压比较,差异无统计学意义(P＞0.05).手术干预后,改良组患者的近期和远期排尿异常率分别为17.39％、0,均明显低于对照组(45.00％、22.50％),差异均有统计学意义(P＜0.05).结论 与腹腔镜下全膀胱根治性切除手术相比,改良根治性膀胱切除术治疗低龄膀胱癌可能在保护性功能和排尿功能方面更具优势,有助于提升患者的性生活质量.
Abstract
Objective To evaluate the effects of modified radical cystectomy on sexual life quality and urination function in young patients with bladder cancer.Methods A total of 86 young patients with bladder cancer admitted to Yulin Red Cross Hospital from November 2020 to No-vember 2023 were retrospectively selected as the study objects.According to the different treatment methods,the patients were divided into the modified group(n=46)and the control group(n=40).In the modified group,part of the prostate envelope was preserved during the vesicec-tomy,and the urinary tract was reconstructed in situ by ileostomy.The control group underwent laparoscopic radical resection of total bladder,ac-companied by traditional urethral reconstruction.The International Index of Erectile function(IIEF)score,semen parameters,bladder function indicators(bladder volume,bladder pressure,bladder residual urine volume and maximum urine flow rate)and the rate of short-term and long-term abnormal urination were compared between the two groups before and 3 months after surgery.Results At 3 months after operation,the IILE scores of the two groups were lower than those before operation,and the IIEF score of the modified group was(20.01±0.64)points,which was significantly higher than that of the control group[(17.34±3.21)points],the difference was statistically significant(P＜0.05).At 3 months after operation,the semen volume of patients in the modified group was significantly lower than that before operation,and the difference was statistically significant(P＜0.05).The semen parameters of the control group were significantly lower than those before operation,and the differences were statistically significant(P＜0.05).The sperm volume,sperm density,sperm activity,sperm motility of the modified group at 3 months after operation were(2.81±0.53)mL,(34.32±10.42)× 106/mL,(55.32±13.52)％and(56.24±10.23)％,respectively,which were significantly higher than those of the control group[(1.32±0.34)mL,(20.24±6.74)×106/mL,(41.32±14.34)％and(41.24±8.35)％],and the differences were statistically significant(P＜0.05).The postoperative bladder capacity and maximum urine flow rate of the modified group were(454.23±54.55)mL and(18.35±3.54)mL/s,respectively,which were significantly higher than those of the control group[(409.24±48.24)mL and(13.45±3.75)mL/s],and the bladder residual urine volume was(21.43±5.76)mL,which was significantly lower than that of the control group[(44.42±10.34)mL],the differences were statistically significant(P＜0.05);there was no statistically significant difference in bladder pressure between the two groups(P＞0.05).After surgical intervention,the short-term and long-term abnormal urination rates in the modified group were 17.39％and 0,respectively,which were significantly lower than those in the control group(45.00％,22.50％),and the differences were statistically significant(P＜0.05).Conclusion Compared with laparoscopic total radi-cal cystectomy,modified radical cystectomy may have more advantages in protecting sexual function and urination function in the treatment of young bladder cancer,which is helpful to improve the quality of life of patients.
维普
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