Wang Sheng-Zheng, Chen Ling-Wu, Zhang Yong-Hai, Wang Wen-Wei, Chen Wei, Lin Huan-Yi
Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, PR China.
Urol Int. 2010;84(1):28-33. doi: 10.1159/000273462. Epub 2010 Feb 17.
To present our experience of hand-assisted laparoscopic radical cystectomy (HALRC) and compare it with open radical cystectomy (ORC).
During the period between May 2004 and November 2007, 31 patients underwent HALRC and 39 patients underwent ORC for bladder cancer. The patient demographics, intraoperative variables and postoperative outcomes were compared retrospectively.
There was no statistically significant difference with regard to age, sex, body mass index, and urinary diversion in the 2 groups. In the HALRC group, 20 patients had stage pT2 or less, 7 had pT3 disease, and 4 had stage pT4 disease. In the ORC group, 29 patients had stage pT2 or less, 5 had pT3 disease, and 5 had stage pT4 disease. All margins in both groups were negative. The HALRC group had decreased blood loss (250.9 vs. 812.8 ml, p < 0.001) and a lower rate of transfusion (9.7 vs. 76.9%, p < 0.001), but similar mean operative time (365.7 vs. 362.6 min, p = 0.862). Time to liquid diet was significantly less in the HALRC group versus the ORC group (4.3 vs. 6.3 days, p < 0.001). The median number of lymph nodes were similar between the HALRC and ORC groups (14 vs. 15, p = 0.377). Six patients developed perioperative complications in the HALRC group and 12 patients had complications in the ORC group (19.4 vs. 30.8%, p = 0.278). Late complications occurred in 3 patients (2 parastomal hernias and 1 ureteroenteral stricture) in the HALRC group.
Compared with ORC, HALRC patients had decreased blood loss, less transfusion requirements, and quicker intestinal recovery. Long-term follow-up in a larger cohort of patients is needed to assess the long-term oncological and functional outcomes.
介绍我们开展手辅助腹腔镜根治性膀胱切除术（HALRC）的经验，并将其与开放性根治性膀胱切除术（ORC）进行比较。
在2004年5月至2007年11月期间，31例患者接受了HALRC，39例患者接受了ORC治疗膀胱癌。对患者的人口统计学资料、术中变量和术后结果进行回顾性比较。
两组在年龄、性别、体重指数和尿流改道方面无统计学显著差异。在HALRC组中，20例患者为pT2期或更低分期，7例为pT3期疾病，4例为pT4期疾病。在ORC组中，29例患者为pT2期或更低分期，5例为pT3期疾病，5例为pT4期疾病。两组的所有切缘均为阴性。HALRC组的失血量减少（250.9对812.8 ml，p < 0.001），输血率较低（9.7%对76.9%，p < 0.001），但平均手术时间相似（365.7对362.6分钟，p = 0.862）。HALRC组恢复流食的时间明显短于ORC组（4.3对6.3天，p < 0.001）。HALRC组和ORC组的中位淋巴结数量相似（14对15，p = 0.377）。HALRC组有6例患者发生围手术期并发症，ORC组有12例患者发生并发症（19.4%对30.8%，p = 0.278）。HALRC组有3例患者发生晚期并发症（2例造口旁疝和1例输尿管肠吻合口狭窄）。
与ORC相比，HALRC患者失血量减少，输血需求降低，肠道恢复更快。需要对更大队列的患者进行长期随访，以评估长期肿瘤学和功能结果。
