比较腹腔镜根治性膀胱切除术后女性体内和体外尿流改道术。
Comparison of intracorporeal and extracorporeal urinary diversions after laparoscopic radical cystectomy in females with bladder cancer.
机构信息
Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan South Li, Chaoyang district, Beijing, 100021, People's Republic of China.
Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongren Tiyuchang Nanlu, Chaoyang district, Beijing, 100020, People's Republic of China.
出版信息
World J Surg Oncol. 2019 Sep 12;17(1):161. doi: 10.1186/s12957-019-1678-5.
PURPOSE
To compare the peri-operative outcomes of females undergoing laparoscopic intracorporeal urinary diversions (ICUD) and extracorporeal urinary diversions (ECUD) after laparoscopic radical cystectomies (LRC).
PATIENTS AND METHODS
Thirty-eight females who underwent LRCs and urinary diversions from February 2008 to October 2018 were divided into two groups: the ECUD group (19 patients) and the ICUD group (19 patients). We retrospectively analysed the patients in terms of patients' demographics, peri-operative outcomes, and oncological follow-ups.
RESULTS
There were significant differences in the mean operative times between ECUDs and ICUDs (364.6 vs. 297.1 min, p = 0.007), transfusion rates (37% vs. 5%, p = 0.042), time to flatus (5 vs. 3 days, p = 0.020), time to ambulation (2 vs. 1 days, p = 0.022), and duration of postoperative hospital stays (22 vs. 13 days, p = 0.002). The mean lymph node yield was 12.9 in the ECUD group and 18.6 in the ICUD group (p = 0.140). Seven out of 19 patients (37%) in the ECUD group and 6 out of 19 patients (32%) in the ICUD group had positive lymph nodes (p > 0.9). Two out of 19 ECUD patients (11%) and 4 of 19 ICUD patients (21%) had positive surgical margins (p = 0.660). Although there were no differences in major complications at 30 days and in all complications at 90 days, the Clavien grade II complications were significantly different at 30 days (ECUD 8, ICUD 2; p = 0.026). The mean follow-up times were 48.7 months (ECUD group) and 26.4 months (ICUD group). There were no statistically significant differences in estimated glomerular filtration rates postoperatively (p = 0.516). Seven patients had disease metastases (ECUD 2 out of 19, ICUD 5 out of 19; p = 0.405) and 5 died (ECUD 3 out of 19, ICUD 2 out of 19; p > 0.9).
CONCLUSIONS
ICUDs benefit females by having smaller incisions, faster recoveries, and decreased complication rates.
目的
比较女性行腹腔镜根治性膀胱切除术（LRC）后行腹腔镜下腔内（ICUD）和腔外（ECUD）尿流改道术的围手术期结局。
方法
回顾性分析 2008 年 2 月至 2018 年 10 月间行 LRC 和尿流改道术的 38 名女性患者，将其分为 ECUD 组（19 例）和 ICUD 组（19 例）。分析患者的人口统计学资料、围手术期结果和肿瘤随访情况。
结果
ECUD 组和 ICUD 组的平均手术时间分别为 364.6 分钟和 297.1 分钟（p=0.007）、输血率分别为 37%和 5%（p=0.042）、排气时间分别为 5 天和 3 天（p=0.020）、下床活动时间分别为 2 天和 1 天（p=0.022）、术后住院时间分别为 22 天和 13 天（p=0.002）。ECUD 组的平均淋巴结检出数为 12.9 个，ICUD 组为 18.6 个（p=0.140）。ECUD 组 19 例患者中有 7 例（37%）和 ICUD 组 19 例患者中有 6 例（32%）出现淋巴结阳性（p>0.9）。ECUD 组有 2 例（11%）和 ICUD 组有 4 例（21%）患者出现切缘阳性（p=0.660）。虽然 30 天和 90 天的主要并发症和所有并发症无统计学差异，但 30 天的 Clavien Ⅱ级并发症差异有统计学意义（ECUD 8 例，ICUD 2 例；p=0.026）。两组的平均随访时间分别为 48.7 个月（ECUD 组）和 26.4 个月（ICUD 组）。术后估算肾小球滤过率无统计学差异（p=0.516）。7 例患者发生疾病转移（ECUD 2 例，ICUD 5 例；p=0.405），5 例死亡（ECUD 3 例，ICUD 2 例；p>0.9）。
结论
ICUD 可通过减少切口、加快恢复速度和降低并发症发生率，使女性患者受益。
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