Prcic Alden, Aganovic Damir, Hadziosmanovic Osman
Urology clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Med Arch. 2013 Dec;67(6):418-22. doi: 10.5455/medarh.2013.67.418-422. Epub 2013 Dec 28.
Determine correlation between complications and stage of the disease and their impact on quality of life in patients with different types of ileal urinary derivation after radical cystectomy, and upon estimation of acquired results, to suggest the most acceptable type of urinary diversion.
In five year period a prospective clinical study was performed on 106 patients, to whom a radical cystectomy was performed due to bladder cancer. Patients were divided into two groups, 66 patients with ileal conduit derivation and 40 patients with orthotopic derivation, whereby in each group a comparison between reflux and anti-reflux technique of orthotopic bladder was made. All patients from both groups filled the Sickness Impact Profile score six months after the operation. All patients had CT urography or Intravenous urography performed, as well as standard laboratory, vitamin B12 blood values, in order to evaluate early (ileus or subileus, wound dehiscence, bladder fistula, rupture of orthotopic bladder, urine extravazation) and late complications (VUR, urethral stricture, ureter stenosis, metabolic acidosis, mineral dis-balance, hypovitaminosis of vitamin B12, increased resorption of bone calcium, urinary infection, kidney damage, relapse of primary disease), so as disease stage and it's impact on quality of life.
From gained results we observe that each category of SIP score correlates with different rate of correlation with the type of operation, group, T, N, and R grade, except work category. Average value of SIP score rises depending on the type of operation and T stage. It is notable that there is no difference in T1 stage, no matter the type of operation. So the average value of SIP score in T1 stage for conduit was 20.3, for Abol-Enein and Ghoneim 17.25 and Hautmann 18.75 respectively. Average value of SIP score in T2 stage for conduit was 31, for Abol-Enein and Ghoneim 19.1 and Hautmann 17.8. Average value of SIP score in T3 stage for conduit was 38.03, for Abol-Enein and Ghoneim 18.75 and Hautmann 19.5. SIP score for T4 was present only in patients with conduit performed and average value od SIP score was 40.42. There is a high level of correlation of late complications and psychosocial and physical dimension with their parameters, while for an independent dimension of correlation is not significant. Early complications have insignificant correlation in all categories of SIP score.
Upon analyzing quality of life and morbidity, significant advantage is given to orthotopic derivations, especially Hautmann derivation with Chimney modification, unless there are no absolute contraindications for performing this type of operation. Factors which mostly influence quality of life are cancer stage, type of derivation, late complications and patient age. SIP score, as a well validated questionnaire, are applicable in this kind of research.
确定根治性膀胱切除术后不同类型回肠代膀胱术患者并发症与疾病分期之间的相关性及其对生活质量的影响，并根据评估所得结果，推荐最可接受的尿流改道类型。
在五年期间，对106例因膀胱癌接受根治性膀胱切除术的患者进行了一项前瞻性临床研究。患者分为两组，66例接受回肠导管代膀胱术，40例接受原位代膀胱术，每组均对原位膀胱的反流和抗反流技术进行了比较。两组所有患者均在术后六个月填写疾病影响量表评分。所有患者均接受了CT尿路造影或静脉尿路造影，以及标准实验室检查、维生素B12血液值检测，以评估早期（肠梗阻或亚肠梗阻、伤口裂开、膀胱瘘、原位膀胱破裂、尿液外渗）和晚期并发症（膀胱输尿管反流、尿道狭窄、输尿管狭窄、代谢性酸中毒、矿物质失衡、维生素B12缺乏、骨钙重吸收增加、泌尿系统感染、肾损害、原发疾病复发），以及疾病分期及其对生活质量的影响。
从所得结果中我们观察到，除工作类别外，疾病影响量表评分的每个类别与手术类型、组别、T、N和R分级的相关率各不相同。疾病影响量表评分的平均值根据手术类型和T分期而升高。值得注意的是，在T1期，无论手术类型如何，均无差异。因此，回肠导管代膀胱术在T1期疾病影响量表评分的平均值为20.3，Abol-Enein和Ghoneim术式为17.25，Hautmann术式为18.75。回肠导管代膀胱术在T2期疾病影响量表评分的平均值为31，Abol-Enein和Ghoneim术式为19.1，Hautmann术式为17.8。回肠导管代膀胱术在T3期疾病影响量表评分的平均值为38.03，Abol-Enein和Ghoneim术式为18.75，Hautmann术式为19.5。T4期的疾病影响量表评分仅出现在接受回肠导管代膀胱术的患者中，疾病影响量表评分的平均值为40.42。晚期并发症与心理社会和身体维度及其参数之间存在高度相关性，而对于独立维度的相关性则不显著。早期并发症在疾病影响量表评分的所有类别中相关性均不显著。
在分析生活质量和发病率时，原位代膀胱术具有显著优势，尤其是采用烟囱改良的Hautmann术式，除非进行此类手术存在绝对禁忌证。对生活质量影响最大的因素是癌症分期、代膀胱术类型、晚期并发症和患者年龄。疾病影响量表评分作为一种经过充分验证的问卷，适用于此类研究。
