腹腔镜膀胱癌根治术后回肠新膀胱与Bricker膀胱远期并发症及生活质量分析

刘贝贝; 郭园园; 陈梦杰; 高五岳; 孙巍; 王金行

doi:10.16766/j.cnki.issn.1674-4152.003492

腹腔镜膀胱癌根治术后回肠新膀胱与Bricker膀胱远期并发症及生活质量分析

doi: 10.16766/j.cnki.issn.1674-4152.003492

蚌埠医科大学第一附属医院泌尿外科，安徽蚌埠 233004

基金项目:

国家自然科学基金项目 81702495

安徽省自然科学基金项目 18080850H279

安徽省高校自然科学研究项目 KJ2021A0706

详细信息

通讯作者:
刘贝贝，E-mail：bb_dynasty@qq.com

中图分类号: R737.14 R730.56
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出版历程
- 收稿日期: 2024-01-25
- 网络出版日期: 2024-07-20

Comparative analyses of long-term complications and aquality of life of ileal new bladder and Bricker bladder after laparoscopic radical surgery for bladder cancer

Department of Urology, the First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui 233004, China

摘要

摘要: 目的比较分析原位回肠新膀胱术(IN)与Bricker回肠膀胱术(Bricker)术后远期并发症情况与生活质量, 为个体化尿流改道方式提供选择依据。方法收集2020年1月-2022年12月蚌埠医科大学第一附属医院泌尿外科收治的行膀胱癌根治术男性患者60例。根据尿流尿道改道方式分为IN组34例和Bricker组26例。分析比较2组术后6个月、12个月的远期并发症情况与患者生活质量。结果 2组手术时间与术中出血量差异无统计学意义(P>0.05), IN组术后肠道恢复时间与住院时间长于Bricker组(P < 0.05);2组6个月总并发症(22例vs.14例)差异无统计学意义(P>0.05), 12个月总并发症(19例vs.23例)差异有统计学意义(P < 0.05);12个月上尿路积水情况IN组优于Bricker组(4例vs.9例P < 0.05);2组生活质量6个月差异无统计学意义(P>0.05), 12个月IN组生活质量显著高于Bricker组(142.82±6.42 vs.118.69±9.92, F=11.128, P < 0.001)。结论 IN对比Bricker具有更少的远期并发症与更高的生活质量, 在尿流改道方式的选择中应予着重考虑。
- 腹腔镜膀胱癌根治术 /
- 回肠新膀胱 /
- Bricker回肠膀胱 /
- 远期并发症 /
- 生活质量
Abstract: Objective To compare and analyze the long-term complications and quality of life in bladder cancer patients who suffered laparoscopic cystectomy and urinary diversion of in situ ileal neobladder (IN) or Bricker ileal orthotopic neobladder (Bricker), providing a basis for selecting individualized urinary diversion. Methods A total of 60 male patients who underwent radical cystectomy were collected in the Urology Department of the First Affiliated Hospital of Bengbu Medical University from January 2020 to December 2022.All patients were divided into the IN group (n=34) and the Bricker group (n=26) according to the methods of urinary diversion.The long-term complications and quality of life were analyzed at 6 months and 12 months after operation. Results There was no significant difference in both operation time and intraoperative blood loss between two groups (P>0.05), but the intestinal recovery time and hospital stay time of patients in IN group were significantly longer than those in Bricker group (P < 0.05).There was no significant difference in the 6-month total complications between the 2 groups (22 cases vs.14 cases), P>0.05, but there was significant difference in the 12-month total complication rates (19 cases vs.23 cases), P < 0.05.However, the upper urinary tract hydronephrosis was better in patients from IN group than those from Bricker group at 12 months (4 cases vs.9 cases, P < 0.05).There was no significant difference IN QOL between the two groups at 6 months (P>0.05), and QOL in the 12 months group was significantly higher than that in the Bricker group (142.82±6.42 vs.118.69±9.92, F=11.128, P < 0.001). Conclusion Fewer long-term complications and higher quality of life are demonstrated in IN, which should be considered seriously when choosing urinary diversion methods.
- Laparoscopic cystectomy for bladder cancer /
- In situ ileal neobladder /
- Bricker ileal orthotopic neobladder /
- Long-term complications /
- Quality of life

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表 1 2组膀胱癌患者临床资料比较

Table 1. Comparison of clinical data for two groups of bladder cancer patients

组别	例数	年龄 (x±s, 岁)	BMI (x±s)	T分期[例(%)]					淋巴结转移 [例(%)]	组织学类型[例(%)]
组别	例数	年龄 (x±s, 岁)	BMI (x±s)	Tis	T1	T2	T3	T4	淋巴结转移 [例(%)]	尿路上皮癌	腺癌	鳞癌
IN组	34	63.46±8.24	24.23±3.54	1(2.94)	5(14.71)	18(52.94)	7(20.59)	3(8.82)	3(8.82)	33(97.06)	0	1(2.94)
Bricker组	26	67.35±8.35	23.90±4.10	1(3.85)	3(11.54)	15(57.69)	5(19.23)	2(7.69)	3(11.54)	23(88.45)	1(3.85)	2(7.70)
统计量		1.938^a	0.334^a	0.057^b					0.008^c	2.090^c
P值		0.058	0.739	0.955					0.931	0.387
注：^a为t值，^b为Z值，^c为χ²值。

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表 2 2组膀胱癌患者围手术期指标比较(x ±s)

Table 2. Comparison of perioperative indicators in two groups of bladder cancer patients (x ±s)

组别	例数	手术时间 (min)	术中出血量 (mL)	术后肠道恢复时间(d)	术后住院时间(d)
IN组	34	286.09±42.69	297.49±53.70	7.31±1.94	15.09±3.86
Bricker组	26	307.77±50.30	310.65±64.43	6.31±1.62	12.96±3.48
t值		1.804	0.863	2.122	2.209
P值		0.076	0.392	0.038	0.031

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表 3 2组膀胱癌患者术后6个月并发症发生情况比较[例(%)]

Table 3. Comparison of postoperative complications in two groups of bladder cancer patients at 6 months [cases (%)]

组别	例数	上尿路积水	肾功能减退	电解质异常	腹壁疝	输尿管-肠管吻合口狭窄	肠代膀胱内结石	合计
IN组	34	3(8.82)	4(11.76)	10(29.42)	1(2.94)	3(8.82)	1(2.94)	22(64.70)
Bricker组	26	4(15.38)	2(7.69)	2(7.69)	1(3.85)	3(11.54)	2(7.69)	14(53.84)
χ²值		0.609	0.278	4.344		0.120	0.697	0.724
P值		0.435	0.598	0.037	0.999^a	0.729	0.404	0.395
注：^a为采用Fisher精确检验。

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表 4 2组膀胱癌患者术后12个月并发症情况[例(%)]

Table 4. Complication status of two groups of bladder cancer patients 12 months post-surgery [cases(%)]

组别	例数	上尿路积水	肾功能减退	电解质异常	腹壁疝	输尿管-肠管吻合口狭窄	肠代膀胱内结石	合计
IN组	34	4(11.76)	5(14.71)	4(11.76)	2(5.88)	4(11.76)	0	19(55.87)
Bricker组	26	9(34.61)	4(15.38)	3(11.54)	1(3.85)	5(19.23)	1(3.85)	23(88.46)
χ²值		4.533	0.005	0.001	0.132	0.638		7.447
P值		0.033	0.942	0.978	0.717	0.424	0.433^a	0.006
注：^a为采用Fisher精确检验。

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表 5 2组膀胱癌患者术后6个月、12个月生活质量比较(x ±s，分)

Table 5. Comparison of quality of life in two groups of bladder cancer patients at 6 and 12 months post-surgery (x ±s, points)

组别	例数	生理状况		家庭状况		功能状况		情感状况		BSS评分		总分
组别	例数	术后6个月	术后12个月	术后6个月	术后12个月	术后6个月	术后12个月	术后6个月	术后12个月	术后6个月	术后12个月	术后6个月	术后12个月
IN组	34	21.50±1.97	23.53±2.15	20.18±2.42	22.53±2.89	19.44±1.74	23.62±2.13	16.77±1.89	19.38±2.42	32.26±2.34	35.76±3.05	110.15±4.68	142.82±6.42
Bricker组	26	20.62±2.00	22.61±3.10	19.30±1.87	21.46±2.35	18.80±2.19	21.76±2.89	17.00±1.41	18.81±2.12	32.11±2.16	34.04±2.72	107.85±4.57	118.69±9.92
统计量		1.703^a	2.398^b	1.535^a	1.161^b	1.261^a	27.594^b	0.519^a	0.583^b	0.254^a	37.148^b	1.905^a	11.128^b
P值		0.093	0.127	0.130	0.286	0.212	< 0.001	0.605	0.448	0.800	< 0.001	0.061	< 0.001
注：^a为t值，^b为F值。

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参考文献(20)

[1]	WITJES J A, BRUINSH M, CATHOMAS R, et al. European association of urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines[J]. Eur Urol, 2021, 79(1): 82-104. doi: 10.1016/j.eururo.2020.03.055
[2]	MULLER G, BUTEA-BOCU M, BROCK O, et al. Association between development of metabolic acidosis and improvement of urinary continence after ileal neobladder creation[J]. J Urol, 2020, 203(3): 585-590. doi: 10.1097/JU.0000000000000583
[3]	WU B, PAN C Y, YAO Z C, et al. A new ureteroileal anastomosis technique in modified ileal orthotopic bladder substitution after radical cystectomy[J]. World J Surg Oncol, 2020, 18(1): 72. doi: 10.1186/s12957-020-01831-w
[4]	DEGBOE A, IVANESCU C, ROHAY J M, et al. Validity and performance of the Functional Assessment of Cancer Therapy-Bladder (FACT-Bl) among advanced urothelial cancer patients[J]. Support Care Cancer, 2019, 27(11): 4189-4198. doi: 10.1007/s00520-019-04709-0
[5]	THOENY H C, SONNENSCHEIN M J, MADERSBACHER S, et al. Is ileal orthotopic bladder substitution with an afferent tubular segment detrimental to the upper urinary tract in the long term[J]. J Urol, 2002, 168(5): 2030-2034. doi: 10.1016/S0022-5347(05)64289-9
[6]	李云云, 韦海荣, 栾婷, 等. 膀胱癌新膀胱术后输尿管肠吻合口狭窄的临床诊疗进展[J]. 现代泌尿外科杂志, 2021, 26(9): 793-797. doi: 10.3969/j.issn.1009-8291.2021.09.019 LI Y Y, WEI H L, LUAN T, et al. Progress in the clinical diagnosis and treatment of uretero-enterostomy stricture after neovesical operation for bladder cancer[J]. Journal of Modern Urology, 2021, 26(9): 793-797. doi: 10.3969/j.issn.1009-8291.2021.09.019
[7]	于靳, 胡敏, 许珊, 等. 根治性膀胱切除并回肠膀胱术不同术前肠道准备措施的效果比较[J]. 实用临床医药杂志, 2019, 23(24): 77-79. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201924025.htm YU J, HU M, XU S, et al. Comparison of different preoperative intestinal preparation measures for radical cystectomy combined with ileal bladder operation[J]. Journal of Practical Clinical Medicine, 2019, 23(24): 77-79. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201924025.htm
[8]	胡春燕, 王先艳, 刘媛, 等. 2种尿流改道术对腹腔镜膀胱癌根治术患者并发症及预后的影响[J]. 实用临床医药杂志, 2023, 27(10): 42-45, 50. doi: 10.7619/jcmp.20230074 HU C Y, WANG X Y, LIU Y, et al. Effects of two kinds of urinary diversion on complications and prognosis of patients undergoing laparoscopic radical bladder cancer surgery[J]. Journal of Practical Clinical Medicine, 2023, 27(10): 42-45, 50. doi: 10.7619/jcmp.20230074
[9]	QIU H, CAO S, XU R. Cancer incidence, mortality, and burden in China: a time-trend analysis and comparison with the United States and United Kingdom based on the global epidemiological data released in 2020[J]. Cancer Commun (Lond), 2021, 41(10): 1037-1048. doi: 10.1002/cac2.12197
[10]	FASANELLA D, MARCHIONI M, DOMANICO L, et al. Neobladder "function": tips and tricks for surgery and postoperative management[J]. Life(Basel), 2022, 12(8): 1193.
[11]	GROBET-JEANDIN E, PINAR U, PARRA J, et al. Health-related quality of life after curative treatment for muscle-invasive bladder cancer[J]. Nat RevUrol, 2023, 20(5): 279-293.
[12]	汪蕾, 李阿文, 卢姗, 等. 思维导图在回肠膀胱造口患者围手术期健康教育中的应用效果[J]. 中华全科医学, 2021, 19(9): 1535-1538, 1614. doi: 10.16766/j.cnki.issn.1674-4152.002105 WANG L, LI A W, LU S, et al. Effect of mind mapping on perioperative health education in patients with ileal cystostomy[J]. Chinese Journal of General Practice, 2021, 19(9): 1535-1538, 1614. doi: 10.16766/j.cnki.issn.1674-4152.002105
[13]	SALIH E M, ABDALLAH M, MOUSSA S, et al. Evaluation of upper urinary tract integrity after radical cystectomy and orthotopic diversion with ileal and sigmoid neobladder[J]. Indian J Surg Oncol, 2021, 12(3): 477-483. doi: 10.1007/s13193-021-01350-4
[14]	THAKARE N, LAMB B W, BIERS S. Orthotopic bladder substitution: surgical aspects and optimization of outcomes[J]. BJUI Compass, 2021, 2(6): 359-369. doi: 10.1002/bco2.84
[15]	BAHLBURG H, HELLMANN T, TULLY K, et al. Psychosocial distress and quality of life in patients after radical cystectomy-one year follow-up in 842 German patients[J]. J Cancer Surviv, 2023. DOI: 10.1007/s11764-023-01400-6.
[16]	CLAPS F, PAVAN N, UMARI P, et al. Incidence, predictive factors and survival outcomes of incidental prostate cancer in patients who underwent radical cystectomy for bladder cancer[J]. Minerva Urol Nephrol, 2021, 73(3): 349-356.
[17]	SIRACUSANO S, D'ELIA C, CERRUTO M A, et al. Quality of life following urinary diversion: orthotopic ileal neobladder versus ileal conduit. A multicentre study among long-term, female bladder cancer survivors[J]. Eur J Surg Oncol, 2019, 45(3): 477-481. doi: 10.1016/j.ejso.2018.10.061
[18]	MICHELS C T J, WIJBURG C J, ABMA I L, et al. Translation and validation of two disease-specific patient-reported outcome measures (Bladder Cancer Index and FACT-Bl-Cys) in Dutch bladder cancer patients[J]. J Patient Rep Outcomes, 2019, 3(1): 62. doi: 10.1186/s41687-019-0149-7
[19]	张士伟, 邓永明, 江波, 等. 原位新膀胱术后功能保留的探索与思考[J]. 中华外科杂志, 2022, 60(11): 969-972. doi: 10.3760/cma.j.cn112139-20220718-00316 ZHANG S W, DENG Y M, JIANG B, et al. Exploration and thinking on functional preservation after orthotopic neobladder construction[J]. Chinese Journal of Surgery, 2022, 60(11): 969-972. doi: 10.3760/cma.j.cn112139-20220718-00316
[20]	李伟, 田良, 刘昊. 膀胱癌根治性全膀胱切除术后行不同尿流改道术对患者生活质量的影响[J]. 现代肿瘤医学, 2019, 27(18): 3285-3288. doi: 10.3969/j.issn.1672-4992.2019.18.028 LI W, TIAN L, LIU H, et al. Comparative study of different procedures of urinary diversion on the quality of life of patients with bladder cancer after radical total cystectomy[J]. Modern Oncology, 2019, 27(18): 3285-3288. doi: 10.3969/j.issn.1672-4992.2019.18.028