背景 全去带乙状结肠原位新膀胱术是治疗肌层浸润性膀胱癌和部分高危表浅性膀胱癌的标准治疗方式,能够有效地增加膀胱容量,降低手术并发症,在临床中得到广泛应用.目的 本研究探讨全去带乙状结肠原位新膀胱术对超重肥胖男性膀胱癌患者在围手术期情况、并发症及尿控方面的影响.方法 回顾性分析39例行全去带乙状结肠原位新膀胱术的膀胱癌患者的临床资料,根据身体质量指数(Body Mass Index,BMI)将患者分为正常体重(BMI≤25 kg/m2)15例、超重肥胖(BMI＞25 kg/m2)24例,记录两组患者的手术时间、术中出血量以及术后住院时间.所有患者术后定期随访,均随访满12个月,观察并记录两组患者术后并发症发生情况、术后6个月控尿能力及术后6个月的尿流动力学检查结果.结果 超重肥胖组手术时间(331.45±76.43)min明显高于正常体重组(291.67±41.65)min,差异有统计学意义(P=0.006);两组患者术中出血量、术后住院时间差异无统计学意义;超重肥胖组患者术后感染及切口并发症6例(25.0％),正常体重组未出现术后感染及切口并发症,差异有统计学意义(P=0.035);两组患者新膀胱最大容量、充盈期膀胱压力、最大尿流率、残余尿量差异无统计学意义;两组患者术后昼、夜控尿率差异无统计学意义.结论 对于男性超重肥胖患者,全去带乙状结肠原位新膀胱术相对安全,早、晚期并发症发生率在可接受范围,新膀胱功能良好,控尿率满意,具有正常尿意,是一种可行的术式.
Clinical efficacy analysis of detaenial sigmoid neobladder reconstruction in overweight and obese male patients with bladder cancer
Background Detaenial sigmoid neobladder reconstruction is a standard treatment method for muscle-invasive bladder cancer and some high-risk superficial bladder cancer.It can effectively increase bladder capacity and reduce surgical complications,and is widely used in clinical practice.Objective To investigate the effect of detaenial sigmoid neobladder reconstruction on perioperative treatment,complications and urinary control in overweight and obese male patients with bladder cancer.Methods The clinical data of 39 patients with bladder cancer who underwent detaenial sigmoid neobladder reconstruction were retrospectively analyzed.According to BMI,the patients were divided into the normal weight group(BMI ≤25 kg/m2,15 patients)and the overweight and obese group(BMI＞25 kg/m2,24 patients).The operation time,intraoperative blood loss and postoperative hospital stay of the two groups were recorded.All patients were followed up regularly for 12 months after surgery.Postoperative complications,urinary control ability 6 months after surgery and urinary flow dynamics results 6 months after surgery were observed and recorded in both groups.Results The surgery time in the overweight and obese group(331.45±76.43)minutes was significantly longer than that in the normal weight group(291.67±41.65)minutes,and the difference was statistically significant(P=0.006);There were no significant differences in intraoperative bleeding volume and postoperative hospital stay between the two groups;Six cases(25.0％)of postoperative infections and incision complications occurred in the overweight and obese group,but no postoperative infections or incision complications in the normal weight group,and the difference between two groups was statistically significant(P=0.035);There were no significant differences in the maximum capacity of the new bladder,bladder pressure during filling period,maximum urine flow rate,and residual urine volume between two groups;There were no significant differences in postoperative diurnal and nighttime urinary control rates between two groups.Conclusion Total removal of detaenial sigmoid neobladder reconstruction has the advantages of relatively simple operation,short operation time,few complications,and good urodynamic characteristics of postoperative neobladder for the treatment of overweight and obese patients with bladder cancer.
detaenial sigmoid neobladder reconstructionoverweightobesitymalebladder cancer
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