【作者】 李晨；

【导师】 王科；

【作者基本信息】 青岛大学 ， 外科学（泌尿外科）（专业学位）， 2021， 硕士

【摘要】 目的对比分析腹腔镜根治性膀胱切除原位回肠膀胱经腹膜外与经腹途径的临床疗效。方法回顾性分析2018年4月至2020年12月收治的61例因膀胱癌行腹腔镜下根治性膀胱切除原位回肠膀胱术患者的临床资料,根据手术方式分为经腹膜外途径与经腹途径两组。经腹膜外途径组患者共26例,其中男性患者20例,女性患者6例。经腹腔途径组35例,男性患者26例,女性患者9例。收集术后90d内并发症的相关资料。比较两组间术后并发症发病率以及其他围手术期结果。结果:61例腹腔镜手术均成功完成,无中转开放病例,经腹膜外组与经腹腔组的手术时间分别为(259.44±49.84)min与(237.09±45.32)min,住院费用(67251.03±10360.60)元与(73128.19±18388.72)元,术中失血量(112.9±31.56)ml与(122±29.89)ml,淋巴结清扫数(15.11±6.19)个与(13.36±4.32)个,P>0.05,无明显差异。经腹膜外组与经腹腔组的术后住院时间为(13.78±4.60)d与(20.18±6.29)d,术后随访90d,术后肠梗阻发生率11.54%(3例)与40.00%(14例),术后并发症发生率42.31%(11例)与77.14%(27例),P<0.05,结果具有统计学差异,经腹膜外途径患者的术后住院时间、术后肠梗阻发生率及术后并发症发生率均明显小于经腹途径患者。结论与腹腔镜根治性膀胱切除原位回肠膀胱经腹途径相比,腹膜外途径可以降低患者术后住院时间以及术后肠道功能恢复时间,减少患者术后并发症的发生,提高临床治疗效果。更多还原

【Abstract】 Objective To compare the efficacy of laparoscopic radical cystectomy with ileal orthotopic neobladder via extraperitoneal and transperitoneal approach.Methods The clinical data of61 patients with bladder cancer who underwent laparoscopic radical cystectomy with ileal orthotopic neobladder for bladder cancer from April 2018 to December 2020 were analyzed retrospectively.They were divided into two groups: extraperitoneal approach and transperitoneal approach according to the mode of operation.In the extraperitoneal group,there were 20 males and 6 females.In the transabdominal group,there were 26 males and 9females.We collected the data of postoperative complications,used Clavien system classification,compared the incidence of postoperative complications between the two groups,and compared the perioperative results between the two groups.Results The operation time was(259.44±49.84)min in the extraperitoneal group and(237.09±45.32)min in the transperitoneal group,and the hospitalization cost was(67251.03±10360.60)yuan and(73128.19±18388.72)yuan,respectively.The intraoperative blood loss was(112.9±31.56)ml and(122±29.89)ml,and the number of lymph node dissection was(15.11±6.19)and(13.36±4.32),respectively,The difference was not statistically significant(P>0.05).The postoperative hospital stay was(13.78 ±4.60)d and(20±6.29)d,respectively.During the90-day follow-up,there was a significant difference in the incidence of postoperative complications between 11(42.31%)and 27(77.14%),the incidence of paralytic ileus was 3(1.54%)and14(40.00%),and the incidence of postoperative complications was6(46.2%)and29(82.8%)(P<0.05).Conclusion Laparoscopic extraperitoneal radical cystectomy with ileal orthotopic neobladder can reduce the incidence of postoperative complications,shorten postoperative hospital stay,speed up the recovery of patients,and is safe and reliable,which is worthy of further promotion.更多还原