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目的评价有盆腹腔手术史的患者行开放和腹腔镜根治性膀胱切除术的可行性和安全性。方法行根治性膀胱切除术并且具有盆腹腔手术史的患者81例。比较开放和腹腔镜根治性膀胱切除术患者的手术时间、术中预计出血量、术中输血例数、留置引流管时间、临床病理分期、术中清除淋巴结个数、切缘阳性例数、肠道功能恢复时间、术后住院时间以及术后90天内并发症的发生率。结果两组患者性别、年龄、体重指数、ASA评分比较,差异无统计学意义。腹腔镜手术组的平均手术时间长于开放手术组(P<0.05),术中失血量和术中需要输血例数低于开放手术组(P<0.01)。开放手术组术中血管损伤率高于腹腔镜手术组(P<0.01)。两组患者术后切缘阳性例数比较差异无统计学意义(P>0.05),但腹腔镜手术组患者术中清除的淋巴结个数多于开放手术(P<0.01)。两组患者在术后并发症发生率比较,差异无统计学意义(P>0.05)。结论对于有手术史的根治性膀胱切除术患者,与开放根治性膀胱切除术比较,腹腔镜手术具有更高的可行性及安全性。
Objective To evaluate the feasibility and safety of open and laparoscopic radical cystectomy in patients with abdominal pelvic surgery. Methods 81 patients underwent radical cystectomy and had a history of pelvic surgery. Comparison of open and laparoscopic radical cystectomy surgery time, intraoperative blood loss expected, intraoperative blood transfusion cases, indwelling drainage tube time, clinical stage, number of clear lymph nodes, the number of cases of positive margins, intestinal Road function recovery time, postoperative hospital stay and the incidence of postoperative complications within 90 days. Results There was no significant difference in gender, age, body mass index and ASA score between the two groups. The average operation time of laparoscopic surgery group was longer than that of open surgery group (P <0.05). The blood loss and intraoperative blood transfusion required were lower than those of open surgery group (P <0.01). The vascular injury rate in open surgery group was higher than that in laparoscopic surgery group (P <0.01). There was no significant difference between the two groups in the number of positive margins after surgery (P> 0.05). However, the number of lymph nodes removed during operation in laparoscopic surgery group was more than that in open surgery group (P <0.01). There was no significant difference in the incidence of postoperative complications between the two groups (P> 0.05). Conclusions Laparoscopic surgery is more feasible and safe than radical cystectomy in radical cystectomy patients with a history of surgery.