【摘要】 【目的】探讨影响膀胱癌根治（RC）尿流改道术围手术期安全的因素。【方法】回顾性收集2001年1月至2020年8月在本中心泌尿外科接受RC术患者的临床病理指标、术后并发症及预后情况等指标并进行统计分析。并对其中2011-2020年的患者按开放手术组（ORC）、腹腔镜组（LRC）、机器人辅助腹腔镜组（RARC）进一步分析比较。本研究采用独立样本t检验、卡方检验、线性回归、K-M生存曲线等统计方法描述患者并发症及预后情况，Logistic回归分析RC术后并发症的影响因素。【结果】在2001-2020年的1 041例行RC术的患者中，中位年龄63(55～69)岁；男性和女性占比分别为86.0%和14.0%。比较2001-2010与2011-2020年前后10年数据，并发症发生率有明显下降（37.4%vs. 26.7%）。分析2011至2020年667例RC术患者的并发症情况，中位随访时间34个月。其中ORC组415例，LRC组161例，RARC组91例。在尿流改道方式中，回肠导管术共计659例，占比63.3%；原位新膀胱术343例，占比32.9%。所有级别并发症发生率30.5%，最常见的并发症是泌尿系并发症（15.8%）。开放手术组总并发症和≥3级并发症发生率高于腹腔镜、机器人手术组（总并发症：ORC,30.8%;LRC,21.1%,RARC,24.2%;P=0.047；≥3级并发症：ORC,14.7%;LRC,9.3%,RARC,6.6%;P=0.043）。线性趋势检验分析提示，本中心患者近期（≤90 d）并发症发生率在2011年至2020年呈下降趋势（χ~2=10.013,P=0.002）。【结论】随着手术技术的提高和经验的积累，RC术后近期并发症发生率有下降趋势；与开放手术相比，微创手术特别是机器人辅助腹腔镜手术在降低并发症发生率上有一定优势。更多还原

【Abstract】 【Objective】To investigate the perioperative safety and complications of radical cystectomy(RC).【Methods】The clinicopathological indexes,postoperative complications and prognosis of patients who underwent RC at Sun Yatsen University Cancer Centre from January 2001 to August 2020 were retrospectively collected and analyzed. Among them,patients from 2011 to 2020 were further analyzed and compared according to the open surgery group(ORC),laparoscopic group(LRC)and robot-assisted laparoscopic group(RARC). Independent sample t test,Chi-square test,K-M survival curve and other statistical methods were used to describe the complications and prognosis of patients,and Logistic regression was used to analyze the influencing factors of complications of RC.【Results】Among the 1041 patients who underwent RC surgery from 2001 to 2020,the median age was 63(55-69) years. In terms of the gender ratio,men were the majority at 86 percent. Compared with that of the first 10 years,the complication rate of the second 10 years decreased significantly(37.4% vs. 26.7%). Complications of 667 patients who underwent RC surgery were analyzed from 2010 to 2020,with a median follow-up of 34 months. A total of 415 patients were enrolled in the ORC group,161 in the LRC group,and 91 in the RARC group. Ileal conduit(659 cases,63.3%)accounted for the highest proportion of all urinary diversion methods,while orthotopic neobladder accounted for the second(343 cases,32.9%). The incidence of all grade complications was 30.5%,and the most common complication was urinary complications. The incidence of total complications and grade ≥3complications in the ORC group was higher than that in the LRC and RARC groups(Total complications:ORC,30.8%;LRC,21.1%,RARC,24.2%;P=0.047;Grade ≥3 complications:ORC,14.7%;LRC,9.3%;RARC,6.6%;P=0.043).【Conclusions】With the improvement of surgical techniques and experience,the incidence of recent postoperative complications after radical resection of bladder cancer in our center has decreased. Compared with open surgery,minimally invasive surgery has some advantages in reducing the complication rate.更多还原