【摘要】：背景與目的： 浸潤性膀胱癌生物學(xué)行為高度惡性,治療的主要方法是膀胱切除加尿流改道術(shù)。根治性手術(shù)能有效提高患者生存率、避免局部復(fù)發(fā)和遠處轉(zhuǎn)移,被認為是標準的手術(shù)方式。但由于根治性膀胱切除及尿流改道術(shù)常給患者帶來生活質(zhì)量的下降及精神上的壓力。每一名膀胱癌患者的身體狀況、手術(shù)耐受性、預(yù)期生存及對治療結(jié)果期待的不同,因此有必要探討適合不同患者需要既達到腫瘤根治又易于被患者接受的膀胱癌根治和尿流改道手術(shù)方式。 自1852年Simon報道為1例膀胱外翻患者施行輸尿管直腸吻合術(shù)以來,尿流改道手術(shù)已有100多年歷史,根椐不同病情和不同手術(shù)醫(yī)師的經(jīng)驗,研究和設(shè)計出各種的手術(shù)方法,不同的術(shù)式各有其適應(yīng)范圍,也各有其優(yōu)缺點。 理想的永久性尿流改道應(yīng)能達到防止術(shù)后并發(fā)癥,保護腎臟功能,使患者能過接近正常的生活。目前使用的各種永久尿流改道方法尚未臻完善,各具優(yōu)缺點�？筛爬橄铝袔最悾孩倌蚵吩炜谑中g(shù)：如輸尿管皮膚造口術(shù)、永久性膀胱造口術(shù)、腹壁尿道術(shù)、尿道造口術(shù)；②利用一段游離腸管于腹壁造口,作為尿流通道,如回腸膀胱術(shù)、結(jié)腸膀胱術(shù)；③尿糞合流手術(shù)：如輸尿管乙狀結(jié)腸造口術(shù)、輸尿管結(jié)腸-結(jié)腸直腸吻合術(shù)；④尿糞分流手術(shù)：如直腸膀胱術(shù)、直腸膀胱-結(jié)腸腹壁造口術(shù)；⑤可控腸膀胱術(shù),分為二類：一類為可控腸膀胱腹壁造口術(shù),如可控回腸膀胱術(shù)、可控回盲腸膀胱術(shù)；另一類為新膀胱術(shù)或正位可控膀胱術(shù),如回腸新膀胱術(shù)、去帶回盲腸新膀胱術(shù)。手術(shù)方法的選擇需按照病人具體情況,如年齡、身體條件、原發(fā)病性質(zhì)、預(yù)期壽命、上尿路及腸管的解剖及功能情況等,既往有無腹部、盆腔手術(shù)及放療史,結(jié)合患者的要求和術(shù)者的經(jīng)驗,認真加以選擇。 輸尿管皮膚造口術(shù)(Cutaneous Ureterostomy, CU)是輸尿管斷端和皮膚的永久性或暫時性尿流改道,這是一種簡單、安全術(shù)式。大體分為兩種類型：輸尿管攀皮膚造口術(shù)和輸尿管末端皮膚造口術(shù)。Roth在1967年最先報道了使用輸尿管皮膚造口術(shù)作為尿流改道的一種方法,原本這種方法用于治療兒童的先天性尿路梗阻,但是后來逐漸擴展到用于治療成人盆腔惡性腫瘤的姑息性尿流改道。目前將輸尿管皮膚造口術(shù)作為永久性尿流改道的方法來使用相對較少,但輸尿管皮膚造口術(shù)仍作為一種有吸引力的永久性尿流改道的方法,尤其適用于晚期膀胱腫瘤。其手術(shù)適應(yīng)癥：1、患膀胱或鄰近器官的晚期惡性腫瘤,膀胱廣泛受累,容量縮小,反復(fù)出血,壓迫輸尿管下段引起腎積水和腎功能不全者；2、兒童患下尿路梗阻或功能性疾患,致上尿路嚴重積水擴張,尤其是合并感染和尿毒癥者；3、患神經(jīng)原性膀胱功能障礙,伴有膀胱輸尿管返流、逆行性腎積水、反復(fù)感染及腎功能受損,不能耐受較大手術(shù)者。 傳統(tǒng)輸尿管皮膚造口術(shù)簡要手術(shù)步驟：(1)需施行膀胱全切除或剖腹探查術(shù)者,使用下腹正中切口,經(jīng)腹腔施行手術(shù)；單純作輸尿管皮膚造口術(shù)者,采用雙下腹斜切口,經(jīng)腹膜外施行手術(shù)。(2)腹膜后分離雙側(cè)輸尿管中下段并將其切斷,近端插入F8輸尿管支架管達腎盂、固定在輸尿管斷端,遠端用絲線貫穿結(jié)扎。(3)在骶岬前方、乙狀結(jié)腸系膜后方作鈍性分離,形成一通道,將一側(cè)輸尿管通過此通道拉至對側(cè)。在離對側(cè)輸尿管斷端約10cm處作輸尿管端側(cè)吻合,將支架引流管經(jīng)吻合口放入對側(cè)輸尿管下段,并插至斷端之外,將輸尿管吻合口前壁縫合,間斷縫合吻合口的輸尿管外膜。(4)將輸尿管造口的一側(cè)的腹部切口延長成S形,兩個梯形皮瓣的長度和底寬均為4cm,頂邊約為2.5-3.0cm,S形切口的中點相當于髂嵴上緣水平。(5)將腹外斜肌腱膜于相對的腹橫肌肌膜創(chuàng)緣縫合數(shù)針,其兩旁的腱膜、肌肉切口則用絲線縫合,形成一紐扣狀通道,讓輸尿管通過此通道拉出腹壁之外。用3-0可吸收線于適當位置穿過輸尿管外膜,并固定于鈕孔邊緣。(6)3-0可吸收線縫合皮膚創(chuàng)緣,形成包繞輸尿管的皮管。用絲線將輸尿管末端與皮緣間斷縫合,并將引流管固定。 傳統(tǒng)的輸尿管末端皮膚造口術(shù)有以下缺點：(1)腹壁切口多、切口長,創(chuàng)傷大,美容效果差；(2)造口周圍皮膚不平坦,易發(fā)生漏尿；(3)易發(fā)生輸尿管末端壞死、狹窄或皮管裂開等合并癥；(4)一些病例術(shù)后皮管逐漸萎縮、變短、使尿液不易收集,而需長期留置引流管；(5)因需要做皮膚乳頭,所需輸尿管長度也較長,易增加輸尿管張力,導(dǎo)致輸尿管血供受限。 基于傳統(tǒng)術(shù)式以上缺點,有必要對其進行改良,以期達到以下效果：(1)手術(shù)方法相對簡單；(2)手術(shù)時間縮短,對患者全身影響小,對病情較重者風(fēng)險降低；(3)減少并發(fā)癥：如減少漏尿、造口周圍感染等。(4)降低手術(shù)風(fēng)險,提高病人的生活質(zhì)量,降低醫(yī)療費用等。 本科室對傳統(tǒng)輸尿管皮膚造口術(shù)進行改良,其的簡要手術(shù)步驟：(1)單側(cè)：取患側(cè)下腹長約12cm手術(shù)斜切口,逐層切開腹壁,腹膜外找到患側(cè)輸尿管中、下段。根據(jù)原發(fā)病確定輸尿管保留輸尿管長度并離斷,遠斷端以絲線縫扎。向上游離輸尿管中下段。于患側(cè)中腹部取一圓形切口,直徑約0.6cm,戳穿下組織,于腹外斜肌腱膜取一同樣大小和形狀的切口,并經(jīng)該切口將輸尿管從圓形皮膚口引出體外。間斷縫合輸尿管壁和腹外斜肌腱膜,以固定輸尿管。以可吸收線間斷縫合輸尿管壁和圓形皮膚切口�？v形切開輸尿管0.5cm,將輸尿管末端外翻、折疊。右輸尿管末端呈乳頭狀突出皮面0.5cm,從該乳頭向輸尿管插6F硅膠管,深度約20cm,或插單“J”管,乳頭上接一造口袋以搜集尿液。 (2)雙側(cè)：取下腹正中切口,起自恥骨聯(lián)合上緣,長約15cm。逐層切開組織,于腹膜外分別找到雙側(cè)輸尿管中下段并橫斷,遠斷端以4號絲線縫扎,分別于兩側(cè)中腹部各取一圓形切口,直徑約0.6cm,切除其下皮下組織,于腹外斜肌腱膜取一同樣大小和形狀的切口,并經(jīng)該切口戳穿腹內(nèi)斜肌和腹橫肌,分別將雙側(cè)輸尿管從左右圓形切口引出體外。以4-0可吸收線間斷縫合輸尿管壁和腹外斜肌腱膜,以固定輸尿管。以5-0可吸收線間斷縫合輸尿管壁和圓形皮膚切口�？v形切開輸尿管0.5cm,將輸尿管末端外翻、折疊。雙側(cè)輸尿管末端呈乳頭狀突出皮面0.5cm。 健康相關(guān)生活質(zhì)量指不同文化和價值體系下,個體受到病情和治療的影響時,對生活和環(huán)境的主觀知覺感受,包括對身體癥狀、社會關(guān)系、心理情緒、環(huán)境互動等的評價。生命質(zhì)量作為一個公認的療效評價指標,能夠幫助臨床醫(yī)生、護士站在患者的立場,選擇和評價治療、護理方案,篩選影響患者生命質(zhì)量的主要因素,有針對性地對患者進行隨訪和完善健康教育。醫(yī)學(xué)模式已經(jīng)發(fā)生了變化,隨著這些變化,在臨床工作中,醫(yī)務(wù)工作者不再只關(guān)注患者生理的治療和康復(fù),還要關(guān)注患者的生理、心理、社會方面的變化。 生活質(zhì)量調(diào)查是目前國際上對包括腫瘤在內(nèi)的各種慢性疾病治療方案篩選和評價的有效方法。所謂健康相關(guān)生活質(zhì)量(HRQOL),是指在疾病、意外損傷及醫(yī)療干預(yù)影響下,與人的生活條件和事件相關(guān)的健康狀態(tài)和主觀滿意度。 本研究通過前瞻性研究傳統(tǒng)輸尿管皮膚造口術(shù)與改良術(shù)式患者的相關(guān)臨床資料,應(yīng)用膀胱癌特異性量表FACT-BL對在我院接受傳統(tǒng)輸尿管皮膚造口術(shù)和改良術(shù)兩種術(shù)式的患者進行問卷調(diào)查,比較兩種術(shù)式術(shù)后相關(guān)并發(fā)癥的發(fā)生率,總體生活質(zhì)量和膀胱癌相關(guān)方面生活質(zhì)量的差別,并探討產(chǎn)生這些差別的原因,為輸尿管皮膚造口術(shù)式的選擇提供健康相關(guān)生活質(zhì)量方面的依據(jù),從而提高患者術(shù)后生活質(zhì)量。 方法：選取2006年12月至2013年02月在廣州市第一人民醫(yī)院泌尿外科住院的患者。病人的入選標準：1、因各種原因需行輸尿管皮膚造口術(shù)者：(1).膀胱或鄰近器官的晚期惡性腫瘤、膀胱廣泛受累,容量縮小,反復(fù)出血,壓迫輸尿管下段引起腎功能衰竭的患者；(2).患神經(jīng)性膀胱功能障礙,伴有膀胱輸尿管返流、上行性腎積水、反復(fù)感染及腎功能受損,不能耐受較大手術(shù)的患者。2、患者無精神疾病,能正確理解問卷內(nèi)容并獨立完成問卷的填寫；3、患者簽署知情同意書。 將手術(shù)組分為傳統(tǒng)手術(shù)組和改良手術(shù)組。其中19例行傳統(tǒng)輸尿管皮膚造口術(shù),22例行改良輸尿管皮膚造口術(shù)。病人的分組標準：從臨床實際出發(fā),病人的分組不可能做到隨機分組。我們的研究根據(jù)主刀醫(yī)生來進行分組,其中以謝克基教授為主刀的治療組施行改良手術(shù)；以其他熟練掌握輸尿管皮膚造口術(shù)的醫(yī)生為主刀的治療組施行傳統(tǒng)術(shù)式。 篩選出符合入選標準的病例41例,其中19例行傳統(tǒng)輸尿管皮膚造口術(shù),22例行改良手術(shù)。收集患者手術(shù)資料,包括手術(shù)時間,術(shù)中出血量,術(shù)后住院時間,術(shù)后并發(fā)癥等資料并進行統(tǒng)計分析。簽署知情同意書,征得患者同意后收集其基本資料,包括患者姓名、性別、年齡、手術(shù)日期、手術(shù)方式、疾病類型、病理類型、腫瘤分期、分級以及患者家庭地址、聯(lián)系電話、E-mai1等內(nèi)容,應(yīng)用膀胱癌特異性量表FACT-BL進行調(diào)查,定期邀患者來我院門診復(fù)查,同時現(xiàn)場完成問卷,或通過郵寄附帶回信郵資和信封,或E-mail發(fā)送電子調(diào)查表以或電話詢問方式完成調(diào)查對兩種術(shù)式患者術(shù)后并發(fā)癥及術(shù)后1個月、3個月、6個月、9個月、12個月等不同時間點的生活質(zhì)量進行多次問卷調(diào)查,從而動態(tài)觀察兩種術(shù)式患者手術(shù)后的生活質(zhì)量變化情況,并對不同時間點兩種術(shù)式方式患者生活質(zhì)量進行比較。 計量資料用均數(shù)±標準差(x±s)表示,比較采用獨立樣本的t檢驗(Independent Samples T Test)或者秩和檢驗(Mann-Whitney Test)進行分析；組間率的比較采用χ2檢驗,,以P=0.05作為檢驗水準。應(yīng)用SPSS13.0軟件對數(shù)據(jù)進行統(tǒng)計分析。 結(jié)果：傳統(tǒng)手術(shù)組：男16例,女3例,年齡67.9±5.4歲；膀胱多發(fā)尿路上皮癌7例、膀胱浸潤性尿路上皮癌4例,膀胱鱗癌1例,膀胱癌術(shù)后復(fù)發(fā)7例；≥T3期8例；其中單側(cè)輸尿管皮膚造口9例,雙側(cè)10例。改良手術(shù)組：男17例,女5例,年齡平均67.8±5.9歲；膀胱多發(fā)尿路上皮癌6例,膀胱癌術(shù)后復(fù)發(fā)5例,膀胱浸潤性尿路上皮癌4例,膀胱尿路上皮癌合并腎盂癌2例,膀胱鱗癌2例,直腸癌侵犯膀胱1例,膀胱平滑肌肉瘤合并前列腺癌1例,膀胱癌陰道轉(zhuǎn)移1例；≥T3期10例；其中單側(cè)輸尿管皮膚造口8例,雙側(cè)14例。(1)兩組患者性別、年齡、性別比例、≥T3期、單數(shù)／雙側(cè)造口比例方面無統(tǒng)計學(xué)差異(P0.05)；(2)、手術(shù)并發(fā)癥：造口感染傳統(tǒng)手術(shù)組高于改良手術(shù)組(P=0.036),乳頭萎縮、末端壞死、外口狹窄兩組之間無差異(P0.05)；(3)、兩組患者術(shù)后1個月、3個月、6個月、9個月、12個月時的HRQOL評分均呈逐漸升高趨勢,術(shù)后1個月、3個月、6個月、9個月時兩組患者HRQOL評分接近,差別無統(tǒng)計學(xué)意義(P0.05)。術(shù)后12個月時,患者改良組HRQOL評分高于傳統(tǒng)手術(shù)組患者,P=0.000.05,兩組間差別有統(tǒng)計學(xué)意義。兩組患者在生理狀況、社會、家庭狀況、情感狀況及FACT-G等方面HRQOL評分接近,差別無統(tǒng)計學(xué)意義(P0.05),而改良組患者在FWB、BSS得分和FACT-BL總得分方面高于傳統(tǒng)組患者,差別有統(tǒng)計學(xué)意義(P0.05)。 結(jié)論：改良輸尿管皮膚造口術(shù)在術(shù)后造口皮膚感染、術(shù)后12個月時HRQOL方面優(yōu)于傳統(tǒng)手術(shù)方式。因此,在患者身體狀況允許的情況下,選擇輸尿管皮膚造口方式時應(yīng)優(yōu)先考慮行改良輸尿管皮膚造口手術(shù),以減少手術(shù)并發(fā)癥和提高患者術(shù)后生活質(zhì)量。
[Abstract]:Background and purpose:
The biological behavior of invasive bladder cancer is highly malignant. The main treatment is cystectomy and urinary diversion. Radical surgery can effectively improve the survival rate of the patients, avoid local recurrence and distant metastasis. However, radical cystectomy and urinary diversion often bring the quality of life to the patients. The physical condition of each bladder cancer patient, surgical tolerance, expectation of survival and the expectation of treatment are different, so it is necessary to explore the way of radical resection of bladder cancer and urinary diversion that are suitable for different patients.
Since Simon reported 1 cases of ureterorectal anastomosis in patients with vesical valgus in 1852, urinary diversion has a history of more than 100 years. According to the experience of different conditions and different surgeons, various surgical methods have been studied and designed. Different surgical methods have their own adaptability and their advantages and disadvantages.
The ideal permanent urinary diversion should be able to prevent postoperative complications, protect the renal function and make patients close to normal life. The various permanent urinary diversion methods currently used have not been perfected and have their own advantages and disadvantages. Surgery, abdominal wall urethra, urethra orostomy; (2) using a segment of free bowel in the abdominal wall orostomy as a channel of urinary flow, such as ileocecal bladder, colon bladder operation, and urinary fecal confluence operation: ureterostomy, ureterocolonic and rectal anastomosis; (4) fecal shunt: rectal bladder, rectum bladder to colon Abdominal orostomy; 5. Controlled enterostomy is divided into two categories: one type of controlled intestinal bladder abdominal orostomy, such as controlled ileocecal bladder, controlled ileocecal cystectomy; the other is new cystectomy or orthotopic bladder operation, such as ileocecal cystectomy, and cecum new bladder operation. The choice of surgical methods should be based on the patient's specific conditions, such as Age, physical condition, primary nature, life expectancy, anatomy and function of the upper urinary tract and bowel, history of abdominal, pelvic surgery and radiotherapy, combined with the patient's requirements and the experience of the surgeon, to choose carefully.
Ureterostomy (Cutaneous Ureterostomy, CU) is a permanent or temporary urinary diversion of the ureteral broken end and skin. This is a simple, safe operation. It is divided into two types: ureterostomy and ureterostomy at the end of ureter. In 1967, ureterostomy was first reported by ureterostomy. A method of urinary diversion, which was used to treat congenital urinary tract obstruction in children, was later extended to the palliative urinary diversion for treatment of adult pelvic malignancies. Ureterostomy is currently used as a permanent urinary diversion, but ureterostomy is relatively less. Still used as an attractive permanent urinary diversion, especially for advanced bladder tumor. Its surgical indications are: 1, advanced malignant tumors of the bladder or adjacent organs, extensive bladder involvement, reduced capacity, repeated bleeding, and oppression of the lower ureteral segment of the kidney and renal insufficiency; 2, children suffering from urinary obstruction or Functional disorders, causing severe water dilatation in the upper urinary tract, especially in patients with infection and uremia, and 3, suffer from neurogenic bladder dysfunction, cystureteral reflux, retrograde hydronephrosis, recurrent infection and impaired renal function, which can not be tolerated by the larger surgeons.
The simple procedure of the traditional ureterostomy: (1) a total cystectomy or exploratory laparotomy should be performed, with a median incision in the lower abdomen and a abdominal operation; a simple ureterostomy, a double lower abdominal incision and extraperitoneal surgery. (2) the posterior subperitoneum and the lower middle ureteral segment are separated and cut off. The F8 ureteral stent was inserted into the renal pelvis at the end of the ureter, and the distal end of the ureter was ligated through the thread. (3) a blunt separation was made in front of the sacral promontory and the posterior sigmoid mesenteric membrane, forming a channel to pull the ureter through the channel to the opposite side. The ureter was anastomosed to the end of the ureter from the contralateral ureter to the end of the ureter, and the stent drainage tube was kissed. The anterior wall of the ureter was inserted into the inferior ureter and inserted into the broken end, sutured the anterior wall of the ureter anastomosis and sutured the ureteral outer membrane of the anastomotic mouth intermittently. (4) the abdominal incision on one side of the ureterostomy was extended into S shape, the length and bottom width of the two trapezoid flaps were both 2.5-3.0cm, and the middle point of the S shaped incision was equivalent to the superior margin of the iliac crest. Level. (5) to stitch the aponeurosis of the abdominis muscle to the relative musculus musculus musculus. The aponeurosis on both sides of the aponeurosis and the incision of the muscles are sutured with silk thread to form a button shaped channel, which allows the ureter to pull out the abdominal wall through this channel. The 3-0 absorbable line passes through the outer membrane of the urinary duct and is fixed to the edge of the buttonhole. (6) 3-0 absorbs the seam. Combined with skin wound, the skin tube was wrapped around ureter. The distal ureter and the skin margin were sutured by silk thread, and the drainage tube was fixed.
The traditional ureterostomy has the following shortcomings: (1) the abdominal wall incision is many, the incision is long, the trauma is big, the beauty effect is poor; (2) the skin around the orostomy is not flat, and the leakage urine is easy to occur; (3) the complications of the ureteral end necrosis, the stenosis or the skin tube cracking are easy to occur. (4) some cases have gradually atrophied and shortened after operation, making urine difficult to receive. (5) because of the need to make skin nipples, the length of ureters needed is longer, and the ureteral tension is easy to increase, resulting in limited blood supply to ureters.
Based on the shortcomings of traditional surgical methods, it is necessary to improve it in order to achieve the following results: (1) the operation method is relatively simple; (2) the time of operation is shortened, the effect of the patient is small, the risk of the serious disease is reduced; (3) reduce the complications, such as reducing the leakage of urine, the infection around the stoma, and so on. (4) reduce the risk of operation and improve the patient's life. Quality, reduce medical expenses and so on.
The improvement of traditional ureterostomy was made in the undergraduate room: (1) unilateral: unilateral ureteral incision in the lower abdomen of the affected side, incision of the abdominal wall by layer by layer, out of the peritoneum and the lower part of the ureter outside the peritoneum. The ureteral retention and ureteral length of the ureter were determined according to the original disease. The distal end of the ureter was ligation with silk thread. Up to the upper end of the ureter, the ureter was sutured with 12cm. The middle and lower middle section of the tube. A circular incision was taken in the middle abdomen of the affected side. The diameter of the incision was about 0.6cm. The incision in the aponeurosis of the abdominal tendinous aponeurosis was taken and the ureter was extracted from the round skin through the incision. The ureter was sutured intermittently to fix the ureter. The ureter was sutured intermittently with the absorbable line. Wall and round skin incision. Longitudinal incision of ureteral 0.5cm, ureteral end to turn out, fold. The end of the right ureter is papillary protrusion 0.5cm, from the nipple to the ureter 6F silicone tube, depth about 20cm, or insert a single "J" tube, nipple on a pocket to collect urine.
(2) bilateral: Taking the middle incision of the lower abdomen, starting from the upper edge of the pubis, opening the tissue by 15cm. layer by layer, finding the middle and lower middle segment of the bilateral ureters and transection separately from the peritoneum. The distal end is ligation of the 4 silk thread, each of the two sides of the middle abdomen is taken a circular incision, the diameter is about 0.6cm, the subcutaneous tissue is removed, and the aponeurosis of the abdominal oblique muscle is equally big. Small and shape incisions were cut through the incision in the abdominal and abdominal transverse muscles, and the bilateral ureters were extracted from the left and right circular incisions. The ureteral wall and the aponeurosis were sutured intermittently by 4-0 absorbable lines to fix the ureter. The ureteral wall and the round skin incision were sutured intermittently with 5-0 absorbable lines. Ureterotomy was made in the longitudinal incision of the ureter 0.5cm The end of the ureter is everted and folded. Papillary protrusion at the ends of the ureter 0.5cm..
Health related quality of life refers to the subjective perception of life and environment, including physical symptoms, social relations, psychological emotions, and environmental interaction when the individual is affected by the condition and treatment of different cultures and values. The quality of life as a recognized therapeutic evaluation index can help clinicians and nursing station. In the position of the patient, the choice and evaluation of the treatment, the nursing plan, the screening of the main factors affecting the quality of life of the patient, the follow-up of the patients and the improvement of health education. The medical model has changed. With these changes, in clinical work, the medical workers are not only concerned with the treatment and rehabilitation of the patients' physiology, but also in the clinical work. Pay attention to the physiological, psychological and social changes of the patients.
The quality of life survey is an effective method for screening and evaluating various chronic diseases, including cancer, and the so-called health related quality of life (HRQOL) refers to the health status and subjective satisfaction of people's living conditions and events under the influence of disease, accidental injury and medical intervention.
The present study conducted a prospective study of the related clinical data of traditional ureterostomy and improved surgical patients, using a bladder cancer specific scale FACT-BL to conduct a questionnaire survey of two patients receiving traditional ureterostomy and modification in our hospital and compared the incidence of postoperative complications of the two surgical procedures. Quality of life and the quality of life related to bladder cancer, and explore the causes of these differences, provide the basis of health related quality of life for the choice of ureterostomy, so as to improve the quality of life after the operation of the patients.
Methods: patients who were hospitalized in the Department of Urology of Guangzhou No.1 People's Hospital from December 2006 to 2013 were selected for admission criteria: 1, for various reasons, ureterostomy was required for various reasons: (1). Late malignant tumors of the bladder or adjacent organs, extensive bladder involvement, reduced capacity, repeated bleeding, and compression of the lower ureter to cause the kidney. Patients with functional failure (2). Neurogenic bladder dysfunction, accompanied by vesical ureteral reflux, ascending hydronephrosis, repeated infection and impaired renal function, unable to tolerate large surgical patients.2, patients without mental illness, can correctly understand the content of the questionnaire and complete the questionnaire independently; and 3, patients sign informed consent.
The operation group was divided into the traditional operation group and the modified operation group. 19 cases were treated with traditional ureterostomy and 22 cases of modified ureterostomy. The group standard of the patients: from the clinical practice, the group of patients could not be randomly divided into groups. Our study was divided into groups according to the doctor, Professor Xie Keji. Modified operation was performed in the treatment group of the main knife, and the traditional operation was performed in the treatment group with other doctors who were skilled in the treatment of ureterostomy.
41 cases were selected, including 19 cases of traditional ureterostomy and 22 cases of improved operation. The data were collected, including operation time, intraoperative bleeding, postoperative hospitalization time, postoperative complications and so on. Including patient name, sex, age, operation date, operation mode, type of disease, pathological type, tumor staging, classification, family address, telephone, E-mai1 and other contents, use bladder cancer specific scale FACT-BL to investigate, invite patients to visit our hospital regularly, complete the questionnaire at the same time, or send a return letter by mail, or send a return letter by mail. Postage and envelope, or E-mail send electronic questionnaire, or telephone inquiry to complete the investigation on the postoperative complications of two surgical patients and the quality of life at 1 months, 3 months, 6 months, 9 months, 12 months and so on, so as to dynamically observe the changes of the quality of life after the operation of the two surgical patients. The quality of life was compared between two surgical methods at different time points.
The measurement data were expressed by mean + standard deviation (x + s), and the independent sample t test was used (Independent S).
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R737.14

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