【摘要】：[目的]對(duì)接受膀胱全切原位尿流改道術(shù)的病人,進(jìn)行術(shù)后近期和遠(yuǎn)期并發(fā)癥統(tǒng)計(jì)分析,并使用FACT-BL量表評(píng)估患者生活質(zhì)量,為進(jìn)一步研究原位尿流改道術(shù)提供依據(jù)。[方法]本研究回顧性分析昆明醫(yī)科大學(xué)第二附屬醫(yī)院泌尿外科2014年1月至2016年11月以來(lái)68例因膀胱癌行膀胱全切原位尿流改道術(shù)患者的術(shù)后并發(fā)癥發(fā)生情況,并使用FACT-BL量表評(píng)估患者生活質(zhì)量。[結(jié)果]全部68例患者接受膀胱全切原位尿流改道術(shù),并全部獲得長(zhǎng)期隨訪�；颊吣挲g39-79歲,平均年齡60.34±9.43歲�；颊呤中g(shù)順利完成,術(shù)后恢復(fù)良好,均康復(fù)出院。在完成隨訪的68例患者中,出現(xiàn)早期并發(fā)癥10例(14.71%),出現(xiàn)晚期并發(fā)癥 11 例(17. 64%);術(shù)前術(shù)后血清 Cr 對(duì)比(t=1.305, P=0.196),BUN 對(duì)比(t=0.358,P=0.764),二者差別均無(wú)統(tǒng)計(jì)學(xué)意義;術(shù)前術(shù)后K+對(duì)比(t=1.347,P=0.169),Na+對(duì)比(t=-1.748, P=0.144), Ca+對(duì)比(t=1.097, P=0.319 ),差別均無(wú)統(tǒng)計(jì)學(xué)意義;C1-對(duì)比(t=-4.701,P=0.000),差別具有統(tǒng)計(jì)學(xué)意義;通過(guò)加強(qiáng)排尿功能訓(xùn)練,隨訪1年,白天可控排尿56例(93. 33%),20例出現(xiàn)夜間尿失禁(33. 33%);術(shù)后6個(gè)月,新膀胱容量(365.02±45.11)ml,最大尿流率(14.36±1.41)ml/s,殘余尿量(26.01±8. 10) ml;術(shù)后隨訪 12 個(gè)月,FACT-BL 總分 124. 8± 13. 4。[結(jié)論]經(jīng)過(guò)1年的隨訪,原位新膀胱患者術(shù)后早期及晚期并發(fā)癥均在可接受的范圍內(nèi),白天與夜間的控尿率均可達(dá)到日常生活的要求,水電解質(zhì)平衡紊亂情況較少,上尿路功能恢復(fù)良好,新膀胱較接近生理狀態(tài)的儲(chǔ)尿、排尿功能。原位新膀胱術(shù)既保存了身體外觀上的完整性,又接近于正常膀胱生理特性,明顯地提高患者的術(shù)后生活質(zhì)量,患者易于接受,是一種比較理想的手術(shù)方式。
[Abstract]:[objective] to evaluate the quality of life (QOL) of patients undergoing total cystectomy and in situ urethral diversion with FACT-BL scale, and to provide a basis for further study of in situ urethral diversion. [methods] from January 2014 to November 2016, 68 patients with bladder cancer undergoing total cystectomy and in-situ urinary diversion were analyzed retrospectively. The quality of life (QOL) was evaluated with FACT-BL scale. [results] all 68 patients underwent total cystectomy and in situ urethral diversion, and all received long-term follow-up. The average age of the patients was 60.34 鹵9.43 years. All patients recovered and were discharged from hospital. Of the 68 patients, 10 (14. 71%) had early complications and 11 (17. 7%) had late complications. There was no significant difference in serum Cr before and after operation (t = 1.305, P = 0.196) and bun (t = 0.358, P ~ (0.764), but there was no significant difference in preoperative and postoperative K (t ~ (1.347) P ~ (0.169) and Na (t ~ (1) -1.748, P ~ (0.144), Ca) (t ~ (1.097, P ~ (0.319), there was no significant difference (t ~ (-4.701) P ~ (0.000). 56 cases (93. 3%) of controlled urination during the day were followed up for 1 year by strengthening the training of urination function. The incidence of nocturnal urinary incontinence was 33% (20 / 20). At 6 months after operation, the maximal urinary flow rate of ml, was (365.02 鹵45.11) ml, (14.36 鹵1.41) ml/s, residual urine volume (26.01 鹵8). 10) the total FACT-BL score of 12 months after ml; operation was 124. 8 鹵13. 4. [conclusion] after one year's follow-up, the early and late complications of patients with neobladder in situ were within the acceptable range, the urinary control rate during the day and at night could meet the requirements of daily life, and the disturbance of water and electrolyte balance was less. The upper urinary tract function recovered well, the new bladder was close to the physiological state of urine storage and urination function. New bladder surgery in situ not only preserves the integrity of the body appearance, but also approaches the normal bladder physiological characteristics. It obviously improves the quality of life of the patients after operation and is easily accepted by the patients. It is an ideal operation method.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.14

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