CAJ | 학술논문

目的比较腹腔镜下根治性膀胱切除术(laparoscopic radical cystectomy,LRC)与开放式根治性膀胱切除术(open radical cystectomy,ORC)术后早期并发症的发病特点.方法收集2011年9月至2014年5月行根治性膀胱切除手术且随访资料完整的患者201例,其中96例行LRC,男86例,女10例,平均年龄(63.7±10.5)岁;105例行ORC,男86例,女19例,平均年龄(64.4±11.4)岁,比较两组患者的手术时间、术中出血量、术后输血例数、术后排气时间、恢复进食时间、引流管拔除时间、术后90 d内早期并发症发生情况等.结果 LRC组和ORC组的手术时间分别为389 min和321 min,术中出血量分别为420 ml和591 ml,术后输血例数分别为15例和29例,术后住院时间分别为16.5d和18.5d,差异均有统计学意义(P＜0.05).LRC组和ORC组术后排气时间分别为3.7d和3.5d,恢复进食时间分别为4.4d和4.3d,引流管拔除时间分别为11.1d和10.9d,差异均无统计学意义(P＞0.05).LRC组和ORC组术后并发症发生率分别为28.1％(27/96)和43.8％ (46/105),差异有统计学意义(P＜0.05).LRC组并发症以感染(7例)、肠梗阻(7例)、淋巴漏(7例)常见,ORC组以感染(14例)、肠梗阻(13例)、切口脂肪液化(11例)常见,LRC组切口脂肪液化1例,与ORC组比较差异有统计学意义(P＜0.05).结论与ORC比较,LRC能显著减少患者术中出血量,降低术后早期并发症的发生率,缩短术后住院时间.
목적 비교복강경하근치성방광절제술(laparoscopic radical cystectomy,LRC)여개방식근치성방광절제술(open radical cystectomy,ORC)술후조기병발증적발병특점.방법 수집2011년9월지2014년5월행근치성방광절제수술차수방자료완정적환자201례,기중96례행LRC,남86례,녀10례,평균년령(63.7±10.5)세;105례행ORC,남86례,녀19례,평균년령(64.4±11.4)세,비교량조환자적수술시간、술중출혈량、술후수혈례수、술후배기시간、회복진식시간、인류관발제시간、술후90 d내조기병발증발생정황등.결과 LRC조화ORC조적수술시간분별위389 min화321 min,술중출혈량분별위420 ml화591 ml,술후수혈례수분별위15례화29례,술후주원시간분별위16.5d화18.5d,차이균유통계학의의(P＜0.05).LRC조화ORC조술후배기시간분별위3.7d화3.5d,회복진식시간분별위4.4d화4.3d,인류관발제시간분별위11.1d화10.9d,차이균무통계학의의(P＞0.05).LRC조화ORC조술후병발증발생솔분별위28.1％(27/96)화43.8％ (46/105),차이유통계학의의(P＜0.05).LRC조병발증이감염(7례)、장경조(7례)、림파루(7례)상견,ORC조이감염(14례)、장경조(13례)、절구지방액화(11례)상견,LRC조절구지방액화1례,여ORC조비교차이유통계학의의(P＜0.05).결론 여ORC비교,LRC능현저감소환자술중출혈량,강저술후조기병발증적발생솔,축단술후주원시간.
Objective To compare the incidence and characteristics of early stage complications between laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC).Methods From September 2011 to May 2014,we retrospectively analyzed the demographic,perioperative data of 96 (86 males and 10 females) and 105 (86 males and 19 females) patients who had undergone LRC and ORC,respectively.The average age of patients was(64.4 ± 11.4) and (63.7 ± 10.5) years old in ORC and LRC group,respectively.We collected operation time,estimated blood loss,number of transfusion,time to resumption of oral intake,postoperative length of drainage freeand complication rate within 90 days after cystectomy.Categorical variables were analyzed with the 2 test or Fisher's exact test as appropriate.Continuous variables were compared using the Student's t-test.Results Mean operative time was significantly longer in LRC group than ORC group (389 vs 321 min,P =0.02).However mean estimated blood loss,postoperative length of stay was significantly less in LRC group than in ORC group (420 vs 591 ml,P =0.003 and 16.5 vs 18.5 d,P =0.04),respectively.Fewer patients in the LRC group need blood transfusion than in ORC group (15 vs 29 patients,P =0.042).The complication rate was significantly less in LRC group as well (28.1％ vs 43.8％,P =0.027).No significant differences were found in time resume the intestinal function(3.7 vs 3.5 d),time to resumption of oral intake (4.4 vs 4.3 d)and time to remove the drainage tube (11.1 vs 10.9 d) between two groups,respectively (P ＞0.05).The incidence of early complication in LRC group was significant lower than that in ORC group(28.1％ vs 43.8％,P ＜0.05) The common complications following LRC were infection (n =7),intestinal obstruction (n =7),lymphatic leak (n =7),while ORC group was infection (n =14),intestinal obstruction (n =13) and liquefied fat (n =11).The incidence of liquefied fat of abdominal incision was significantly less in the LRC group than ORC group (1 vs 11 patients,P =0.006).Conclusion Patients can benefit more from LRC than ORC,because LRC can help to reduce estimated blood loss,postoperative transfusion and complication as well as postoperative length of stay.