膀胱癌根治性全膀胱切除术后不同尿流改道术式临床应用对照探究.doc

膀胱癌根治性全膀胱切除术后不同尿流改道术式临床应用对照探究 [摘要] 目的 探讨膀胱癌根治性全膀胱切除术后回肠膀胱术和原位回肠新膀胱术的应用价值。 方法 选取2013年6月～2015年4月我院接收的符合研究选取标准采用根治性全膀胱切除术治疗的64例膀胱癌患者，根据切除术后不同尿流改道术式分为研究组（n=29）与对照组（n=35）。对照组行回肠膀胱术，研究组行原位回肠新膀胱术。对比两组手术情况、不良反应发生情况及治疗前后两组生活质量评分变化情况，并于术后1年对患者进行随访，统计两组疾病复发率及存活率。 结果 研究组手术用时、住院时间及术中出血量均明显多于对照组，差异有统计学意义（Plt;0.05）；研究组尿路感染发生率为6.90%，明显低于对照组的28.57%，差异有统计学意义（Plt;0.05），两组肾功能损害、切口开裂、肺部感染、不完全性肠梗阻、吻合口狭窄、尿瘘、贮尿囊结石发生率比较，差异无统计学意义（Pgt;0.05）；研究组复发率为3.45%、存活率为100.00%，对照组复发率为5.71%、存活率为100.00%，差异均无统计学意义（Pgt;0.05）；治疗前两组生理职能、生理机能、一般健康状况、躯体疼痛、精神健康、精力状态、情感职能及社会功能评分对比差异无统计学意义（Pgt;0.05），经治疗，两组各项指标均较治疗前有所改善，且研究组生理职能、生理机能、一般健康状况、躯体疼痛、精神健康及社会功能优于对照组，差异有统计学意义（Plt;0.05）。结论 回肠膀胱术及原位回肠新膀胱术均可在行根治性全膀胱切除术的膀胱癌患者中取得显著疗效，且均具有一定安全性，回肠膀胱术手术及住院用时、出血量少，原位回肠新膀胱术对患者生活质量改善效果更加显著，临床实际可根据患者具体情况选取最佳治疗方案。　　[关键词] 膀胱癌根治性全膀胱切除术；回肠膀胱术；原位回肠新膀胱术；生活质量　　[中图分类号] R737.14 [文献标识码] A [文章编号] 1673-9701（2016）21-0010-04　　[Abstract] Objective To discuss the application value of bricker operation and orthotopic ileal neobladder after radical total cystectomy for bladder cancer. Methods 64 patients with bladder cancer treated by radical total cystectomy in our hospital from June 2013 to April 2015 were selected and divided into study group （n=29） and control group （n=35） according to different procedures of urinary diversion. Patients in the control group were given bricker operation， and patients in the study group were given orthotopic ileal neobladder. Parameters of operation， incidence of adverse reactions， and changes of life quality scores before and after treatment were compared between two groups. The patients were followed up at 1 year after operation and the recurrence rate and survival rate were compared. Results The operation duration， hospital stay， and intra-operative blood loss were significantly longer/higher in the study group than in the control group （Plt;0.05）. The incidence rate of urinary tract infection （UTI） was 6.90% in the study group， which was significantly lower than the 28.57% in the control group（Plt;0.05）. There w