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目的:探讨腹腔镜根治性膀胱全切除联合回肠原位新膀胱术对膀胱癌的疗效及尿动力学的影响。方法:将70例膀胱癌患者按照手术方法分为开放组(开放手术,31例)和腹腔镜组(腹腔镜手术,39例),记录两组患者的手术时间、术中出血量、胃肠功能恢复时间、住院时间、淋巴结清扫数量及术后并发症发生率。术后3个月检查两组患者的最大尿流率、膀胱容量、充盈期膀胱压力、排尿时最大膀胱压、最大尿道压、残留尿量等尿动力学指标,并记录两组患者术后3、6个月时的控尿率。结果:两组手术时间、淋巴结清扫数量比较,差异无统计学意义(P>0.05),与开放组比较,腹腔镜组术中出血量显著减少,胃肠功能恢复时间及住院时间显著缩短,差异均有统计学意义(P<0.05)。两组术后主要并发症有肠梗阻、代谢性酸中毒、新膀胱尿道吻合口狭窄、泌尿系统反复感染、切口疝等,两组各种并发症发生率比较,差异无统计学意义(P>0.05)。术后随着时间的延长,两组患者的控尿率逐渐增加,且日间控尿率高于夜间;两组术后3、6个月日间和夜间的控尿率比较,差异均无统计学意义(P>0.05)。术后3个月,两组患者最大尿流率、膀胱容量、充盈期膀胱压力、排尿时最大膀胱压、最大尿道压、残留尿量比较,差异均无统计学意义(P>0.05)。结论:腹腔镜根治性膀胱全切除联合回肠原位新膀胱术创伤小、出血量少,胃肠功能恢复快,术后控尿率、尿动力学指标与开放手术相近。
Objective: To investigate the effect of laparoscopic radical cystectomy combined with ileal orthotopic neobladder on the curative effect and urodynamics of bladder cancer. Methods: Seventy patients with bladder cancer were divided into open group (open operation, 31 cases) and laparoscopic group (laparoscopic operation, 39 cases) according to the operation method. The operation time, blood loss, Functional recovery time, length of stay, number of lymph node dissection and incidence of postoperative complications. At 3 months after operation, the maximum urinary flow rate, bladder volume, bladder pressure at filling stage, maximum bladder pressure during urination, maximum urethral pressure and residual urine volume were measured in two groups and the urodynamic parameters of the two groups were recorded after operation 3 , 6 months when the rate of urine control. Results: There was no significant difference in the number of operation time and lymph node dissection between the two groups (P> 0.05). Compared with the open group, the amount of bleeding in the laparoscopic group was significantly reduced, the recovery time of gastrointestinal function and hospitalization time were significantly shorter, the difference All were statistically significant (P <0.05). The main complications of the two groups were intestinal obstruction, metabolic acidosis, neovaginal anastomosis stenosis, recurrent urinary system infection and incisional hernia. There was no significant difference in the incidence of various complication between the two groups (P> 0.05). With the extension of time after surgery, the two groups of patients with control of urine increased gradually, and daytime control of urine was higher than at night; 3,6 months after operation daytime and nighttime control two groups, the difference was not Statistical significance (P> 0.05). At 3 months after operation, the maximum urinary flow rate, bladder volume, bladder pressure at filling stage, maximal bladder pressure at urination, maximal urethral pressure and residual urine volume were not significantly different between the two groups (P> 0.05). Conclusions: Laparoscopic radical cystectomy combined with ileal neobladder has less trauma, less bleeding and faster recovery of gastrointestinal function. The rate of urine control and urodynamics after operation is similar to open operation.