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目的探讨膀胱保留术综合治疗方案对浸润性膀胱癌(muscle invasive bladder cancer,MIBC)患者生存率的影响。方法选取2008年5月—2011年5月本院收治的行手术治疗的90例MIBC患者作为研究对象,随机分为对照组和观察组各45例。对照组常规采取根治性膀胱切除术(radical cystectomy,RC)治疗,观察组采取膀胱保留术综合治疗方案。术后定期复查与随访,记录并比较两组术中出血量、膀胱冲洗时间、手术时间、住院时间、术后并发症发生情况及患者4年内生存率。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果观察组患者术中出血量、膀胱冲洗时间、手术时间及住院时间分别为(103.65±31.33)ml、(1.15±0.43)d、(46.31±10.24)min、(8.05±1.36)d,对照组分别为(697.86±82.14)ml、(2.01±0.81)d、(162.19±32.55)min、(15.28±2.95)d,两组比较差异均有统计学意义(均P<0.05)。观察组患者术后并发症发生率为4.44%,明显低于对照组的17.78%,差异有统计学意义(P<0.05)。观察组与对照组4年内生存率分别为64.44%、71.11%,两组比较差异无统计学意义(P>0.05)。结论对MIBC患者采取膀胱保留术综合治疗方案,其生存率与RC相当,且保持了较好的膀胱功能,并发症发生率降低。但仅限于强烈要求保留膀胱或不耐受RC的患者,不适用于晚期患者,术后应严格行复查与随访程序。
Objective To investigate the effect of the comprehensive treatment of bladder cancer on the survival rate of patients with invasive bladder cancer (MIBC). Methods Totally 90 MIBC patients who underwent surgical treatment in our hospital from May 2008 to May 2011 were selected and randomly divided into control group and observation group of 45 cases. The control group was treated with radical cystectomy (RC) routinely, while the observation group was treated with bladder preservation. Periodical follow-up and follow-up were performed. The intraoperative blood loss, bladder irrigation time, operation time, hospital stay, postoperative complication and patient’s 4-year survival rate were recorded and compared. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The intraoperative blood loss, bladder irrigation time, operation time and hospital stay in the observation group were (103.65 ± 31.33) ml, (1.15 ± 0.43) d, (46.31 ± 10.24) min, (8.05 ± 1.36) d, (697.86 ± 82.14) ml, (2.01 ± 0.81) d, (162.19 ± 32.55) min and (15.28 ± 2.95) d respectively. There were significant differences between the two groups (all P <0.05). The incidence of postoperative complications in the observation group was 4.44%, which was significantly lower than that in the control group (17.78%), the difference was statistically significant (P <0.05). The 4-year survival rates of the observation group and the control group were 64.44% and 71.11% respectively, with no significant difference between the two groups (P> 0.05). Conclusions The comprehensive treatment of MIBC with bladder preservation has the same survival rate as that of RC with better bladder function and lower complication rate. However, patients who are strongly limited to reserving bladder or intolerant RC are not suitable for advanced patients. Postoperative follow-up procedures should be strictly followed.