摘要
目的探讨膀胱癌根治性膀胱切除术(RC)联合原位新膀胱患者的术后并发症及其影响因素、处理措施及转归,并对不同亚组间并发症情况进行比较。方法回顾性分析2010年4月至2021年10月行RC+原位回肠新膀胱术的103例患者的临床资料,以及术后并发症发生情况、处理措施及转归,并对机器人辅助根治性膀胱切除术(RARC)与腹腔镜根治性膀胱切除术(LRC)、U型膀胱与W型膀胱、肌层浸润性膀胱癌(MIBC)与非肌层浸润性膀胱癌(NMIBC)组间的并发症情况进行比较。结果103例患者中,男98例,女5例;平均年龄(56.9±9.4)岁,中位随访时间为46(5~137)个月,总体并发症发生率为56.3%。Logistic回归分析显示,RARC为新膀胱术后并发症发生的保护性因素(OR=0.182,95%CI=0.044~0.755,P=0.019)。此外,卡方检验显示,RARC组的总体并发症(23.1%vs 66.7%)、早期并发症(11.5%vs 52.0%)和CCSⅠ~Ⅱ(23.1%vs 54.7%)、CCSⅢ~Ⅴ(3.8%vs 25.3%)、新膀胱相关(3.8%vs 34.7%)、非新膀胱相关(19.2%vs 49.3%)并发症发生率均显著低于LRC组(P<0.05)。对于不同新膀胱类型的患者,U型膀胱的总体并发症(61.9%vs 31.6%)和新膀胱相关并发症(31.0%vs 5.3%)发生率显著高于W型膀胱,其在CCSⅠ~Ⅱ(51.2%vs 26.3%)中亦有显现(P<0.05)。MIBC与NMIBC患者的并发症发生率差异无统计学意义。结论RC联合原位新膀胱术后并发症大多可以得到较好的处理和转归。RARC相较于LRC能够显著降低并发症发生率,膀胱癌分期并不会影响术后并发症的发生。
Objective To investigate the incidence,treatment,and prognosis of postoperative complications in patients who underwent radical cystectomy(RC)followed by ileal neobladder,as well as to compare the complications among subgroups.Methods We conducted a retrospective analysis of clinical data on 103 patients who underwent orthotopic ileal neobladder in our center from April 2010 to October 2021.Complications were classified according to their relationship to the neobladder and time of occurrence and the postoperative complications,management measures and prognosis were comprehensively analyzed and described.On the basis,discrepancies among subgroups of complications were compared,including robot-assisted radical cystectomy(RARC)vs laparoscopic radical cystectomy(LRC),“U”vs“W”shaped ileal neobladder and muscle-invasive bladder cancer(MIBC)vs non muscle-invasive bladder cancer(NMIBC).Results A total of 103 patients(98 males and 5 females)were enrolled in our center,with a median follow-up time of 46(5-137)months.The patients'average age was(56.9±9.4)years old.The overall complication rate was 56.3%.The logistic analysis revealed that RARC was a protective factor for the occurrence of complications(OR=0.182,95%CI=0.044-0.755,P=0.019).Additionally,the chi-square test indicated that the RARC group experienced significantly fewer complications(23.1%vs 66.7%),early complications(11.5%vs 52.0%),CCSⅠ-Ⅱ(23.1%vs 54.7%),CCSⅢ-Ⅴ(3.8%vs 25.3%),neobladder related(3.8%vs 34.7%),and non-neobladder related(19.2%vs 49.3%)than LRC group(P<0.05).For patients who underwent different neobladder types,the overall(61.9%vs 31.6%)and neobladder related(31.0%vs 5.3%)complication rates were significantly higher in U-shaped neobladder.However,there was no significant difference in the complications between patients with MIBC and those with NMIBC.Conclusions Most of the complications after neobladder have a better prognosis.RARC has been shown to significantly lower the complication rate when compared to LRC,while the BCa stage did
作者
蔡令凯
杨潇
曹强
李鹏超
袁宝瑞
吴启开
庄俊涛
李凯
吕强
CAI Lingkai;YANG Xiao;CAO Qiang;LI Pengchao;YUAN Baorui;WU Qikai;ZHUANG Juntao;LI Kai;LV Qiang(Department of Urology,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《现代泌尿生殖肿瘤杂志》
2023年第1期15-20,共6页
Journal of Contemporary Urologic and Reproductive Oncology
基金
江苏省人民医院2021年度临床能力提升工程项目(JSPH-MC-2021-15)。
关键词
膀胱癌
根治性膀胱切除术
原位新膀胱
并发症
Bladder carcinoma
Radical cystectomy
Orthotopic ileal neobladder
Complication
