Autorino R, Quarto G, Di Lorenzo G, De Sio M, Perdonà S, Giannarini G, Giugliano F, Damiano R
Clinica Urologica, AOU Policlinico, Seconda Università degli Studi, Napoli, Italy.
Eur J Surg Oncol. 2009 Aug;35(8):858-64. doi: 10.1016/j.ejso.2008.08.002. Epub 2008 Sep 27.
To compare health related quality of life (HRQOL) between patients with two different types of urinary diversion, ileal conduit and orthotopic neobladder, and between them and an age-matched population of healthy subjects.
Eighty eight patients treated with radical cystectomy for bladder cancer at our institutions between 2002 and 2007 were contacted for this survey. All of them had a follow-up of more than 12 months after surgery and were recurrence free. The SF-36 questionnaire was provided to each patient during a follow-up visit at outpatient clinics. Overall, 79 patients (90%) returned the questionnaire and were included in this analysis. They were divided into two groups: group 1 comprised 44 patients with an ileal conduit diversion, and group 2 included 35 patients with a neobladder. As a control, normative values of an age-matched healthy Italian population were considered.
No significant difference was found in scale scores between the neobladder and ileal conduit groups. Scale scores for role-physical functioning, social functioning and role-emotional functioning in both the neobladder and ileal conduit groups were significantly below the Italian population norm. Patients with a neobladder 65 years old or older (n=18) had significantly lower scores for role-physical functioning and role-emotional functioning than those younger than 65 years (n=17; p<0.05).
Few differences between ileal conduit and orthotopic bladder substitution have been detected. Thus, the assumption that continent reconstruction provides better HRQOL than ileal conduit diversion cannot be supported. Patient education and active participation in treatment decisions seem to be the key to postoperative satisfaction.
比较两种不同类型尿流改道（回肠膀胱术和原位新膀胱术）患者之间以及他们与年龄匹配的健康受试者群体之间的健康相关生活质量（HRQOL）。
联系了2002年至2007年间在我们机构接受膀胱癌根治性膀胱切除术的88例患者进行本次调查。他们均在术后有超过12个月的随访且无复发。在门诊随访期间向每位患者提供了SF - 36问卷。总体而言，79例患者（90%）返回了问卷并纳入本分析。他们被分为两组：第1组包括44例行回肠膀胱改道的患者，第2组包括35例行新膀胱术的患者。作为对照，考虑了年龄匹配的健康意大利人群的标准值。
新膀胱组和回肠膀胱组之间的量表得分未发现显著差异。新膀胱组和回肠膀胱组在角色 - 身体功能、社会功能和角色 - 情感功能方面的量表得分均显著低于意大利人群标准。65岁及以上行新膀胱术的患者（n = 18）在角色 - 身体功能和角色 - 情感功能方面的得分显著低于65岁以下患者（n = 17；p < 0.05）。
回肠膀胱术和原位膀胱替代术之间几乎没有差异。因此，不能支持可控性重建比回肠膀胱改道能提供更好的HRQOL这一假设。患者教育和积极参与治疗决策似乎是术后满意度的关键。
