原位回腸新膀胱術(shù)與Bricker回腸膀胱術(shù)臨床療效對比研究
發(fā)布時間：2019-05-23 23:44
【摘要】：目的：探討膀胱癌患者行改良根治性膀胱切除原位回腸新膀胱術(shù)與根治性膀胱切除Bricker回腸膀胱術(shù)的臨床療效，為膀胱癌患者選擇更好的尿流改道方式提供臨床參考。方法：選擇行改良根治性膀胱切除原位回腸新膀胱術(shù)（24例）與根治性膀胱切除Bricker回腸膀胱術(shù)（16例）的膀胱癌患者為研究對象。對兩組不同尿流改道方式患者的年齡、伴隨疾病、腫瘤臨床分期及病理分級、淋巴結(jié)陽性率、手術(shù)時間、術(shù)中出血量、住院時間、術(shù)后并發(fā)癥、圍手術(shù)期死亡率及再手術(shù)率、腫瘤復發(fā)率、生存率等方面進行比較分析；患者術(shù)后1年通過復查方式進行隨訪，采用膀胱癌特異性量表（FACT-BL）對兩組患者健康生活質(zhì)量進行評分,對評分結(jié)果進行比較分析。結(jié)果：原位回腸新膀胱術(shù)組與Bricker回腸膀胱術(shù)組患者在年齡、伴隨疾病、腫瘤臨床分期及病理分級、圍手術(shù)期死亡率及再手術(shù)率、淋巴結(jié)陽性率方面比較無統(tǒng)計學差異(P0.05）。原位回腸新膀胱術(shù)組與Bricker回腸膀胱術(shù)組患者在手術(shù)時間(391.04±62.78min vs314.38±43.5min）、術(shù)中出血量(1110.42±59.46ml vs871.87±246.85ml）、住院時間(34.13±6.12d vs28.43±5.80d）方面比較，差異有統(tǒng)計學意義（P0.05)。原位回腸新膀胱術(shù)組患者與Bricker回腸膀胱術(shù)組患者的尿路感染發(fā)生率比較（8.33%vs37.5%)，差異有統(tǒng)計學意義(P0.05)。原位回腸新膀胱術(shù)組患者與Bricker回腸膀胱術(shù)組患者在不全性腸梗阻發(fā)生率（8.33%vs37.5%）、肺部感染率（4.17%vs0%）、切口裂開率（4.17%vs0%）、漏尿率（12.5%vs6.25%）、出口梗阻率（8.33%vs6.5%）方面比較，差異無統(tǒng)計學意義（P0.05)。原位回腸新膀胱術(shù)組患者與Bricker回腸膀胱術(shù)組患者在1年腫瘤復發(fā)率（0%vs0%)和1年生存率（100%vs100%）比較無差異，，兩組在3年腫瘤復發(fā)率（0%vs6.25%）和生存率（95.583%vs93.75%）比較，差異無統(tǒng)計學意義（P0.05)。應用FACT-BL量表對患者術(shù)后1年健康生活質(zhì)量進行評分，原位回腸新膀胱術(shù)組與Bricker回腸膀胱術(shù)組患者在社會/家庭狀況(SWB)(21.77±1.20分vs21.3±1.86分）、精神狀況(EWB)（20.27±2.14分vs19.5±1.45分）方面評分比較，兩組差異無統(tǒng)計學意義（P0.05)。然而在軀體狀況（PWB)（22.00±1.98分vs20.57±1.34分）、功能狀況(FWB）（21.59±2.15分vs17.64±1.86分）、膀胱癌特異性模塊（BSS)（33.77±2.71分vs28.57±2.44分）、一般癌癥功能評價系統(tǒng)（FACT-G)（85.64±4.16分vs79.07±3.27分）及膀胱癌特異評價系統(tǒng)（FACT-BL)（119.41±5.59分vs107.64±4.07分)評分方面比較，差異有統(tǒng)計學意義(P0.05)。原位回腸新膀胱術(shù)組患者與Bricker回腸膀胱術(shù)組患者在喜歡自己的體表情況(95.4%vs28.6%,P0.001)、對性有興趣(59.0%vs28.6%,P0.05)、有勃起和維持功能（72.7%vs14.2%，P0.001）方面比較，差異有統(tǒng)計學意義（P0.05)。結(jié)論：改良根治性膀胱切除原位回腸新膀胱術(shù)組患者雖然在手術(shù)時間、術(shù)中出血量、住院時間方面與根治性膀胱切除Bricker回腸膀胱術(shù)比較無優(yōu)勢，但是前組手術(shù)方式治療膀胱癌患者可以取得與后者同樣的臨床效果。并且改良根治性膀胱切除原位回腸新膀胱術(shù)患者術(shù)后健康生活質(zhì)量明顯高于根治性膀胱切除Bricker回腸膀胱術(shù)組患者,而且前者術(shù)中保留性神經(jīng)血管束，有效的保留患者性功能，提高患者術(shù)后生活質(zhì)量，值得在臨床上推廣應用。
[Abstract]:Objective: To study the clinical effect of radical cystectomy and radical cystectomy with radical cystectomy in patients with bladder cancer. Methods: The patients with bladder cancer (16 cases) of radical cystectomy and radical cystectomy (16 cases) underwent radical cystectomy and radical cystectomy (16 cases) were selected. The age, the associated disease, the clinical stage of the tumor and the pathological grade, the positive rate of the lymph node, the operative time, the intraoperative blood loss, the hospital stay, the postoperative complications, the perioperative mortality and the reoperation rate and the recurrence rate of the tumor in the two groups of different urine flow diversions. The survival rate and other aspects were compared and analyzed. The follow-up was carried out in 1 year after the operation of the patient, and the health quality of the two groups was assessed by using the bladder cancer specific scale (FACT-BL), and the results of the scores were compared and analyzed. Results: There was no significant difference in the age, the concomitant diseases, the clinical stage of the tumor and the pathological grade, the perioperative mortality and the reoperation rate and the positive rate of the lymph node in the in-situ ileal new-bladder operation group (P0.05). In the in-situ ileal new bladder group, the operative time (391.04-62.78 min vs314.38-43.5 min), the intraoperative blood loss (1110.42, 59.46 ml vs871,87-246.85 ml) and the hospital stay (34.13-6.12 d vs28.43-5.80 d) were statistically significant (P0.05). The incidence of urinary tract infection (8.33% vs.5%) in the patients with the in-situ ileal new bladder group and the Bricker ileal-bladder group was statistically significant (P0.05). In the patients with in-situ ileal new bladder, the incidence of total intestinal obstruction (8.33% vs37.5%), pulmonary infection rate (4.17% vs0%), incision dehiscence rate (4.17% vs0%), leakage rate (12.5% vs6.25%) and outlet obstruction rate (8.33% vs6.5%) were not statistically significant (P0.05). In the in-situ ileal new bladder group, the recurrence rate (0% vs0%) and the 1-year survival rate (100% vs100%) of the patients in the Bricker ileal bladder group were not significantly different in the 1-year tumor recurrence rate (0% vs0%) and the 1-year survival rate (100% vs100%), and no significant difference was found between the two groups in the 3-year tumor recurrence rate (0% vs6.25%) and the survival rate (95.583% vs90.75%) (P0.05). The postoperative 1-year health quality of the patient was scored using the FACT-BL scale, and the in-situ ileal new bladder group was compared with the Bricker ileal bladder group in the social/ family condition (SWB) (21.77-1.20 points vs21.3-1.86), the mental state (EWB) (20.27-2.14 points vs19.5-1.45), There was no significant difference between the two groups (P0.05). However, in the body condition (PWB) (22.00-1.98 points vs20.57-1.34), functional status (FWB) (21.59-2.15 points vs17.64-1.86 points), bladder cancer-specific module (BSS) (33.77-2.71 points vs28.57-2.44 points), The general cancer function evaluation system (FACT-G) (85.64-4.16 sub-vs79.07-3.27) and the bladder cancer-specific evaluation system (FACT-BL) (119.41-5.59 sub-vs107.64-4.07 points) scored a statistically significant difference (P0.05). In the patients with in-situ ileal new bladder, the patients with the Bricker's ileal bladder had an interest in sex (59.0% vs28.6%, P <0.05), with an interest in sex (59.0% vs28.6%, P <0.05), and the difference was statistically significant (P <0.05). Conclusion: The modified radical cystectomy and in-situ ileal new bladder operation group has no advantage in the operation time, the intraoperative blood loss, the hospital stay and the radical cystectomy and the Bricker ileal bladder operation. However, the same clinical effect as the latter can be obtained in the treatment of bladder cancer by the operation of the previous group. and the improved radical cystectomy in-situ ileal new cystectomy patient has a significantly higher quality of life after operation than the radical cystectomy Bricker ileal bladder, and the former retains the neurovascular bundle, effectively retains the patient's sexual function, and improves the quality of life of the patient after surgery, And is worthy of being popularized and applied clinically.
【學位授予單位】：瀘州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.14
本文編號：2484346
[Abstract]:Objective: To study the clinical effect of radical cystectomy and radical cystectomy with radical cystectomy in patients with bladder cancer. Methods: The patients with bladder cancer (16 cases) of radical cystectomy and radical cystectomy (16 cases) underwent radical cystectomy and radical cystectomy (16 cases) were selected. The age, the associated disease, the clinical stage of the tumor and the pathological grade, the positive rate of the lymph node, the operative time, the intraoperative blood loss, the hospital stay, the postoperative complications, the perioperative mortality and the reoperation rate and the recurrence rate of the tumor in the two groups of different urine flow diversions. The survival rate and other aspects were compared and analyzed. The follow-up was carried out in 1 year after the operation of the patient, and the health quality of the two groups was assessed by using the bladder cancer specific scale (FACT-BL), and the results of the scores were compared and analyzed. Results: There was no significant difference in the age, the concomitant diseases, the clinical stage of the tumor and the pathological grade, the perioperative mortality and the reoperation rate and the positive rate of the lymph node in the in-situ ileal new-bladder operation group (P0.05). In the in-situ ileal new bladder group, the operative time (391.04-62.78 min vs314.38-43.5 min), the intraoperative blood loss (1110.42, 59.46 ml vs871,87-246.85 ml) and the hospital stay (34.13-6.12 d vs28.43-5.80 d) were statistically significant (P0.05). The incidence of urinary tract infection (8.33% vs.5%) in the patients with the in-situ ileal new bladder group and the Bricker ileal-bladder group was statistically significant (P0.05). In the patients with in-situ ileal new bladder, the incidence of total intestinal obstruction (8.33% vs37.5%), pulmonary infection rate (4.17% vs0%), incision dehiscence rate (4.17% vs0%), leakage rate (12.5% vs6.25%) and outlet obstruction rate (8.33% vs6.5%) were not statistically significant (P0.05). In the in-situ ileal new bladder group, the recurrence rate (0% vs0%) and the 1-year survival rate (100% vs100%) of the patients in the Bricker ileal bladder group were not significantly different in the 1-year tumor recurrence rate (0% vs0%) and the 1-year survival rate (100% vs100%), and no significant difference was found between the two groups in the 3-year tumor recurrence rate (0% vs6.25%) and the survival rate (95.583% vs90.75%) (P0.05). The postoperative 1-year health quality of the patient was scored using the FACT-BL scale, and the in-situ ileal new bladder group was compared with the Bricker ileal bladder group in the social/ family condition (SWB) (21.77-1.20 points vs21.3-1.86), the mental state (EWB) (20.27-2.14 points vs19.5-1.45), There was no significant difference between the two groups (P0.05). However, in the body condition (PWB) (22.00-1.98 points vs20.57-1.34), functional status (FWB) (21.59-2.15 points vs17.64-1.86 points), bladder cancer-specific module (BSS) (33.77-2.71 points vs28.57-2.44 points), The general cancer function evaluation system (FACT-G) (85.64-4.16 sub-vs79.07-3.27) and the bladder cancer-specific evaluation system (FACT-BL) (119.41-5.59 sub-vs107.64-4.07 points) scored a statistically significant difference (P0.05). In the patients with in-situ ileal new bladder, the patients with the Bricker's ileal bladder had an interest in sex (59.0% vs28.6%, P <0.05), with an interest in sex (59.0% vs28.6%, P <0.05), and the difference was statistically significant (P <0.05). Conclusion: The modified radical cystectomy and in-situ ileal new bladder operation group has no advantage in the operation time, the intraoperative blood loss, the hospital stay and the radical cystectomy and the Bricker ileal bladder operation. However, the same clinical effect as the latter can be obtained in the treatment of bladder cancer by the operation of the previous group. and the improved radical cystectomy in-situ ileal new cystectomy patient has a significantly higher quality of life after operation than the radical cystectomy Bricker ileal bladder, and the former retains the neurovascular bundle, effectively retains the patient's sexual function, and improves the quality of life of the patient after surgery, And is worthy of being popularized and applied clinically.
【學位授予單位】：瀘州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.14
【參考文獻】
相關(guān)期刊論文 前2條
1 韓蘇軍;張思維;陳萬青;李長嶺;;中國膀胱癌發(fā)病現(xiàn)狀及流行趨勢分析[J];癌癥進展;2013年01期
2 周芳堅;劉卓煒;余紹龍;韓輝;秦自科;李永紅;王歡;;改良全膀胱切除原位新膀胱術(shù)96例報告[J];中華泌尿外科雜志;2006年08期
本文編號：2484346
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