Perlin D V, Alexandrov I V, Zippunnikov V P, Shmanev A O
FGBOU VO Volgograd State Medical University of the Ministry of Health of Russia.
GBUZ Volgograd Regional Center of Urology and Nephrology, Volgograd, Russia.
Urologiia. 2019 Dec 31(6):54-59.
Despite considerable progress during last decade, laparoscopic radical cystectomy (LRC) still remains a complex and time-demanding procedure. The number of patients with baseline chronic kidney diseases has gradually increased.
to compare the results of our novel technique of LRC with late dividing of the ureters with conventional procedure.
A total of 50 patients with bladder cancer, who underwent to LRC in a single clinic between April 2013 and January 2017, were included in the study. A conventional LRC was performed in 25 patients, while in other 25 cases, a novel technique of LRC was used. In all cases, LRC was done with fully intracorporeal urinary diversion. Statistical analysis was performed using the Shapiro-Wilk test for parametric testing. In order to compare two groups, Student t-test was used for independent samples.
There were no significant differences between two groups in average length of procedure, blood loss volume and length of hospital stay. Major intraoperative complications (injury of the rectum) occurred in two patients, one in each group. Both cases were successfully managed intraoperatively. In addition, there were two postoperative complications in each group that required repeat intervention. The mean serum creatinine level on the 2nd day after surgery was significantly higher after conventional LRC (171.6 and 147.7 mol/L), while glomerular filtration rate was significantly lower (58 and 72 ml/min/1.73 m2), compared to group of novel technique of LRC with late dividing of the ureters. A total of four patients in group of conventional LRC and two patients in group of novel technique had cancer progression. Two patients (one in each group) died because of cancer progression after 15 and 34 months after surgery. The mean follow-up was 25.6 (12-39) months after LRC with late dividing of the ureters and 33.2 (18-48) months in group of standard LRC.
LRC with late dividing of the ureters allow to prevent prolonged contact of hyperosmolar and, in some cases, non-sterile urine with peritoneum and decrease inflammation and risk of postoperative adhesions. Using of novel technique may decrease rate of perioperative nephropathy, which is especially important in patients with decreased renal function (single functioning kidney, hydronephrosis, diabetes, renal failure, adjuvant chemotherapy). However, more procedures and longer follow-up period are necessary in order to evaluate ontological results of the novel technique.
尽管在过去十年中取得了显著进展，但腹腔镜根治性膀胱切除术（LRC）仍然是一个复杂且耗时的手术。基线慢性肾脏病患者的数量逐渐增加。
比较我们采用输尿管延迟离断的新型LRC技术与传统手术的结果。
本研究纳入了2013年4月至2017年1月在单一诊所接受LRC的50例膀胱癌患者。25例患者接受传统LRC，另外25例采用新型LRC技术。所有病例均采用完全体内尿流改道。使用Shapiro-Wilk检验进行参数检验的统计分析。为比较两组，采用独立样本的Student t检验。
两组在平均手术时长、失血量和住院时间方面无显著差异。主要术中并发症（直肠损伤）发生在2例患者中，每组各1例。两例均在术中成功处理。此外，每组各有2例术后并发症需要再次干预。与采用输尿管延迟离断的新型LRC技术组相比，传统LRC术后第2天的平均血清肌酐水平显著更高（分别为171.6和147.7 μmol/L），而肾小球滤过率显著更低（分别为58和72 ml/min/1.73 m²）。传统LRC组共有4例患者和新型技术组2例患者出现癌症进展。2例患者（每组各1例）在术后15个月和34个月因癌症进展死亡。采用输尿管延迟离断的LRC术后平均随访时间为25.6（12 - 39）个月，标准LRC组为33.2（18 - 48）个月。
输尿管延迟离断的LRC可避免高渗且在某些情况下非无菌尿液与腹膜的长时间接触，减少炎症和术后粘连风险。采用新技术可能降低围手术期肾病的发生率，这在肾功能减退的患者（单肾功能、肾积水、糖尿病、肾衰竭、辅助化疗）中尤为重要。然而，为评估新技术的肿瘤学结果，需要更多手术病例和更长的随访期。
