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目的观察无管化腹腔镜全膀胱切除原位回肠新膀胱术的临床疗效。方法回顾性研究我院2013年3月至2016年3月收治的膀胱癌患者30例,根据手术方法分为A组(无管化腹腔镜全膀胱切除术)、B组(输尿管造口术)、C组(开放性原位回肠代膀胱术)三组,分别观察其手术时间长短、术中出血量多少、术后肠道功能恢复情况,术后控尿量好坏、术后并发症情况等临床指标,观察比较确定回肠代膀胱术的临床应用价值。结果 A组11例,B组9例,C组10例。A组手术时间(4.43±0.78)h、肠道功能恢复天数(1.51±1.59)d、平均出血量(500.31±54.60)ml,明显优于B、C组,除平均手术时间外其余两项指标差异均有统计学意义(P均<0.05)。术后前期,所有患者新膀胱充盈良好,早期均有尿失禁;几个月后患者日间控尿良好率95%,夜间控尿良好率为80%;C组共有5例患者仍有尿失禁,其中1例开放性手术患者出现膀胱结石和膀胱出血;且A组无并发症发生。结论腹腔镜下膀胱全切除回肠新膀胱术的临床效果良好,手术创口小、出血量少,恢复快等优点。
Objective To observe the clinical effect of laparoscopic total cystectomy in situ ileal neo-bladder surgery. Methods A retrospective study of 30 patients with bladder cancer admitted to our hospital from March 2013 to March 2016 was divided into group A (laparoscopic total cystectomy), group B (ureterostomy) , Group C (open ipsilateral ileal neobladder) three groups were observed the length of operation, how much blood loss, postoperative intestinal function recovery, postoperative control of urine output, postoperative complications And other clinical indicators, to determine the clinical application of ileal replacement of bladder. Results A group of 11 cases, B group 9 cases, C group 10 cases. The average operative time (4.43 ± 0.78) h, the number of recovery days of intestinal function (1.51 ± 1.59) d and the average amount of bleeding (500.31 ± 54.60) ml in group A were significantly better than those in group B and C The differences were statistically significant (all P <0.05). In the early postoperative period, all patients had a good filling of the new bladder with incontinence in the early stage. After a few months, the rate of good urine control during the day was 95% and that of nighttime urine control was 80%. In 5 patients in Group C, urinary incontinence , Of which 1 case of open surgery patients with bladder stones and bladder hemorrhage; and A group without complications. Conclusions The laparoscopic total neobladder with ileal neobladder has good clinical effect, small operation wound, less bleeding and quick recovery.