Chen Xiaonong, Wang Weigao, Xiang Anping, Li Yuehong
Department of Urology, The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, China.
Transl Androl Urol. 2020 Apr;9(2):665-672. doi: 10.21037/tau.2020.03.16.
To explore the value of orthotopic spiral ileal bladder substitution (OSIBS) following radical cystectomy in treating bladder cancer patients by investigating the short- and long-term postoperative complications and assessing the quality of life in patients who had undergone OSIBS.
The post-operative complications were retrospectively analyzed among bladder cancer patients who had undergone radical cystectomy + OSIBS in our center from January 2001 to January 2017. The quality of life was assessed by using the Function Assessment of Cancer Therapy-Bladder Cancer Form (FACT-BL). Patients were followed up by mails, telephone, and outpatient visits.
A total of 68 subjects were included in this study. All patients undergoing radical cystectomy + OSIBS were followed up for an extended period. The patients aged 39-68 years (mean: 60.34±9.43 years). The surgeries were completed, and all the patients were smoothly discharged after good postoperative recovery. Of the 68 patients who had completed the follow-up visits, 10 had early complications (14.71%), and 11 (17.64%) developed late complications. The blood urea nitrogen (BUN) (t=0.358, P=0.764) and serum creatinine (Cr) (t=1.305, P=0.196) levels showed no significant difference before and after surgery. The serum potassium (t=1.347, P=0.169), sodium (t=-1.748, P=0.144), and calcium (t=1.097, P=0.319) levels also showed no significant changes before and after surgery. However, the change in serum chlorine level was statistically significant (t=-4.701, P=0.000). To support urinary function, the patients were encouraged to take exercises During the 10-year follow-up period, the daytime urinary continence rate reached 94.1% (n=64) in the daytime, and the nighttime incontinence rate was 13.2% (n=9). Six months after the surgery, the neobladder capacity was (365.02±45.11) mL, the maximum flow rate was (14.36±1.41) mL/s, and the post-voiding residual (PVR) was (26.01±8.10) mL. The total FACT-BL score was (124.8±13.4) during the 10-year follow-up.
After 10 years of follow-up, the early and late complications in patients who had undergone radical cystectomy + OSIBS were within acceptable range and the daily and nightly continence levels allowed normal daily life. OSIBS not only preserves the physical integrity of the body but also has normal physiological characteristics of the bladder. It remarkably improves the postoperative quality of life and can be easily accepted by patients. Therefore, it is an ideal surgical procedure.
通过调查根治性膀胱切除术后原位螺旋回肠膀胱替代术（OSIBS）的近期和远期并发症，并评估接受OSIBS患者的生活质量，探讨其在膀胱癌患者治疗中的价值。
回顾性分析2001年1月至2017年1月在本中心接受根治性膀胱切除术+OSIBS的膀胱癌患者的术后并发症。采用癌症治疗功能评估-膀胱癌量表（FACT-BL）评估生活质量。通过邮件、电话和门诊随访患者。
本研究共纳入68例受试者。所有接受根治性膀胱切除术+OSIBS的患者均进行了长期随访。患者年龄39-68岁（平均：60.34±9.43岁）。手术均顺利完成，所有患者术后恢复良好后顺利出院。在完成随访的68例患者中，10例发生早期并发症（14.71%），11例（17.64%）发生晚期并发症。血尿素氮（BUN）（t=0.358，P=0.764）和血清肌酐（Cr）（t=1.305，P=0.196）水平在手术前后无显著差异。血清钾（t=1.347，P=0.169）、钠（t=-1.748，P=0.144）和钙（t=1.097，P=0.319）水平在手术前后也无显著变化。然而，血清氯水平的变化具有统计学意义（t=-4.701，P=0.000）。为了维持排尿功能，鼓励患者进行锻炼。在10年的随访期内，白天尿失禁率达到94.1%（n=64），夜间尿失禁率为13.2%（n=9）。术后6个月，新膀胱容量为（365.02±45.11）mL，最大尿流率为（14.36±1.41）mL/s，残余尿量为（26.01±8.10）mL。10年随访期间FACT-BL总分（124.8±13.4）。
经过10年的随访，接受根治性膀胱切除术+OSIBS患者的早期和晚期并发症在可接受范围内，白天和夜间的控尿水平允许正常的日常生活。OSIBS不仅保留了身体的完整性，而且具有膀胱的正常生理特征。它显著提高了术后生活质量，且患者易于接受。因此，它是一种理想的手术方法。
