CAJ | 학술논문

目的：比较开放及腹腔镜根治性膀胱全切-回肠原位新膀胱术的临床疗效。方法回顾性分析我院自2010年9月至2014年3月行开放（ORC）及腹腔镜（LRC）根治性膀胱全切-回肠原位新膀胱术患者的资料，其中ORC组13例，LRC组21例。对两组患者的术前基本资料、围术期数据、术后并发症情况、术后控尿情况及肿瘤学随访数据进行对比分析。结果LRC组较ORC组具有术中出血量少（P＝0．013）、术后恢复进食时间短（P＝0．001）、住院时间短（P＝0．005）的特点。两组在术后并发症发生率方面无明显差异（P＝0．725）。所有患者术后切缘均为阴性，两组患者在淋巴结清扫个数（P＝0．393）以及淋巴结阳性率（P＝0.562）方面无统计学差。中位随访时间28．5个月（8～47个月）。在术后1年内，LRC组与ORC组在日间控尿率（88．2％vs．84．6％，P＝0．773）及夜间控尿率（70．6％vs．76．9％，P＝0．697）无明显差异。在随访过程中，4例患者发生肿瘤复发或转移，其中盆腔复发2例，脑转移1例，肺转移1例。3例患者死亡。LRC组与ORC组在肿瘤特异性生存率及无复发生存率上无统计学差异（P均＞0．05）。结论与开放手术相比，腹腔镜根治性膀胱全切-回肠原位新膀胱术具有术中出血少、术后恢复快的特点，其术后控尿功能及肿瘤学结果与开放手术疗效相当，因此应作为首选手术方案。
목적：비교개방급복강경근치성방광전절-회장원위신방광술적림상료효。방법회고성분석아원자2010년9월지2014년3월행개방（ORC）급복강경（LRC）근치성방광전절-회장원위신방광술환자적자료，기중ORC조13례，LRC조21례。대량조환자적술전기본자료、위술기수거、술후병발증정황、술후공뇨정황급종류학수방수거진행대비분석。결과LRC조교ORC조구유술중출혈량소（P＝0．013）、술후회복진식시간단（P＝0．001）、주원시간단（P＝0．005）적특점。량조재술후병발증발생솔방면무명현차이（P＝0．725）。소유환자술후절연균위음성，량조환자재림파결청소개수（P＝0．393）이급림파결양성솔（P＝0.562）방면무통계학차。중위수방시간28．5개월（8～47개월）。재술후1년내，LRC조여ORC조재일간공뇨솔（88．2％vs．84．6％，P＝0．773）급야간공뇨솔（70．6％vs．76．9％，P＝0．697）무명현차이。재수방과정중，4례환자발생종류복발혹전이，기중분강복발2례，뇌전이1례，폐전이1례。3례환자사망。LRC조여ORC조재종류특이성생존솔급무복발생존솔상무통계학차이（P균＞0．05）。결론여개방수술상비，복강경근치성방광전절-회장원위신방광술구유술중출혈소、술후회복쾌적특점，기술후공뇨공능급종류학결과여개방수술료효상당，인차응작위수선수술방안。
Objective To compare the clinical outcomes of laparoscopic cystectomy (LRC) and open radical cystectomy (ORC) in the treatment of orthotopic ileal neobladder .Methods The demographic parameters of patients ,perioperative da-ta ,postoperative complications ,new bladder function and oncology results were recorded and evaluated .Results The LRC group had less estimated blood loss (P=0 .013) ,shorter oral intake time (P=0 .001) and hospital stay (P=0 .005) compared with the ORC group . There was no difference in postoperative complications ( P= 0 .725 ) , the mean number of dissected lymph nodes (P=0 .393) ,and lymph node positive rate (P=0 .562) between the two groups .The median follow-up was 28 .5 months (8~47 months) .One year after operation ,the day-time and night-time continence rate were 88 .2% and 70.6% for the LRC group ,84 .6% and 76 .9% for the ORC group (P>0 .05) ,with no statistical significance .During the follow-up ,4 patients developed tumor recurrence and metastasis .There was no significant difference in cancer-specific survival rates and re-currence-free survival rates between the two groups (all P>0 .05 ) .Conclusions Compared with open radical cystectomy , laparoscopic cystectomy has advantages of less blood loss ,earlier oral intake and shorter hospital stay in the treatment of ortho-topic ileal neobladder .Additionally ,it produces comparable continence and tumor control as open radical cystectomy;there-fore ,laparoscopic cystectomy should be the optimal treatment modality .