CAJ | 학술논문

目的：总结腹腔镜膀胱全切回肠（Bricker）膀胱术与原位回肠（Hautmann）新膀胱术治疗浸润性膀胱癌的经验及近期疗效。方法该院2010～2014年施行腹腔镜Bricker膀胱术74例，Hautmann新膀胱术30例，回顾性分析比较两组患者手术时间、出血量等术中情况、术后肠道功能恢复、术后并发症及术后肿瘤复发转移等临床资料。结果两组在平均手术时间、术中出血量、术中输血率、盆腔淋巴结清扫数目、术后住院时间等方面差异无统计学意义（P＞0．05）。两组淋巴结阳性共8例（7．8％），合并前列腺癌3例（2．9％），无切缘阳性病例。Bricker膀胱术组、Hautmann新膀胱术组术后肠道功能恢复时间分别为（4．2±1．4）、（5．3±2．2）d ，P＝0．002，并发症发生率分别为31．9％（23例）、53．3％（16例），P＝0．043。 Hautmann新膀胱术组患者术后6个月白天和夜间尿控分别为76．9％、57．7％，术后12个月白天和夜间尿控分别为90．9％、81．8％。 Hautmann新膀胱术组术后2例（7．7％）复发转移，Bricker膀胱术组术后9例（14．1％）复发转移。结论 Bricker膀胱术和Hautmann新膀胱术具有相似肿瘤根治效果，但Hautmann新膀胱术患者术后生活质量更高。
목적：총결복강경방광전절회장（Bricker）방광술여원위회장（Hautmann）신방광술치료침윤성방광암적경험급근기료효。방법해원2010～2014년시행복강경Bricker방광술74례，Hautmann신방광술30례，회고성분석비교량조환자수술시간、출혈량등술중정황、술후장도공능회복、술후병발증급술후종류복발전이등림상자료。결과량조재평균수술시간、술중출혈량、술중수혈솔、분강림파결청소수목、술후주원시간등방면차이무통계학의의（P＞0．05）。량조림파결양성공8례（7．8％），합병전렬선암3례（2．9％），무절연양성병례。Bricker방광술조、Hautmann신방광술조술후장도공능회복시간분별위（4．2±1．4）、（5．3±2．2）d ，P＝0．002，병발증발생솔분별위31．9％（23례）、53．3％（16례），P＝0．043。 Hautmann신방광술조환자술후6개월백천화야간뇨공분별위76．9％、57．7％，술후12개월백천화야간뇨공분별위90．9％、81．8％。 Hautmann신방광술조술후2례（7．7％）복발전이，Bricker방광술조술후9례（14．1％）복발전이。결론 Bricker방광술화Hautmann신방광술구유상사종류근치효과，단Hautmann신방광술환자술후생활질량경고。
Objective To summary the experience of laparoscopic cystectomy ileal conduit (Bricker) and orthotopic ileal neo‐bladder (Hautmann) and compare the short‐term efficacy of the two types of urinary diversion for invasive bladder cancer . Methods Retorspective analysis of the patients in our hospital who accepted laparoscopic radical cystectomy from 2010 to 2014 was performed ,74 of them accepted ileal conduit ,and 30 of them accepted orthotopic ileal neobladder .The general clinical data ,postop‐erative recovery ,postoperative complications and Oncology feature were analyzed and compared between the two groups .Results There was no demonstrable difference was found in operation time ,blood loss ,intraoperative blood transfusion rate ,the number of removed lymph node ,average hospital stay ,specimens positive margin rate and postoperative pathology results between the two groups (P>0 .05) .But there were significant difference in postoperative intestinal function recovery time[(4 .2 ± 1 .4)d ,(5 .3 ± 2 .2)d] ,(P=0 .002) ,and the complication rates 31 .9% (23 cases)vs .53 .3% (16 case) ,P=0 .043 .After 6 months ,the daytime and nighttime urinary control were 76 .9% ,57 .7% ,after 12 months ,the daytime and nighttime urinary control increased to 90 .9% , 81 .8% .2 cases(7 .7% ) were diagnosed with recurrence or metastasis during follow‐up in Hautmann group ,while 9 cases(14 .1% ) were diagnosed with recurrence or metastasis in Bricker group .Conclusion Two kinds of surgical procedures both have the similar therapeutic effect ,but the postoperative quality of life is better for Hautmann orthotopic neobladder patients .