经腹腔镜手术与开放手术治疗原发性膀胱憩室临床效果比较
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摘要
目的比较经腹腔镜手术与开放手术治疗原发性膀胱憩室的临床效果。方法回顾性分析2009年9月至2016年7月收治的22例原发性膀胱憩室患者的临床资料,分为开放手术组12例,腹腔镜手术组10例。采用两独立样本均数t检验,比较两组患者手术时间及术中出血量。采用配对t检验,分别比较两组患者术前、术后排尿时膀胱压力及尿流率结果。采用两独立样本均数近似t检验,比较两组患者术前、术后排尿时膀胱压力及尿流率数值变化。结果腹腔镜手术组较开放手术组手术时间延长(P<0.05),出血量减少(P<0.05)。开放手术组术后随访(13.6±4.0)个月,腹腔镜手术组术后随访(13.6±5.7)个月。两组患者术后排尿时膀胱压力均较术前降低(P<0.05);术后最大尿流率均较术前增加(P<0.05)。术后患者尿流曲线改善。比较两组患者术前、术后排尿时膀胱压力及尿流率数值变化,差异均无统计学意义(P>0.05)。术后均未再出现膀胱输尿管返流,无膀胱憩室复发,排尿正常,未再出现排尿困难。结论经腹腔镜切除原发性膀胱憩室,手术创伤小,出血少,与开放手术效果无明显差异,是理想的微创手术方式。
Objective To compare the therapeutic effects of laparoscopic surgery and open surgery on primary bladder diverticula. Methods The data of 22 patients with primary bladder diverticula enrolled from September 2009 to July2016 were retrospectively reviewed. Twelve patients underwent open bladder diverticulectomy( open surgery group),ten patients underwent laparoscopic diverticulectomy( laparoscopy group). The operation time and operative hemorrhage of the two groups were compared with independent sample t test. The pre-operative and post-operative urodynamics were separately compared with paired-samples t test. The numerical variations of voiding detrusor pressure and maximum pressure flowin the two groups were compared with separate variance estimation t test. Results The operation time in laparoscopy group was longer than that in open surgery group( P < 0. 05). The operative hemorrhage in laparoscopy group was less than that in open surgery group( P < 0. 05). The follow-up time of open surgery group was( 13. 6 ±4. 0) months. The follow-up time of laparoscopy group was( 13. 6 ± 5. 7) months. The post-operative voiding detrusor pressure was lower than that in pre-operation in both groups( P < 0. 05). The maximum pressure flowincreased after the operation in both groups( P < 0. 05). Urine flowcurve was improved after the operation. The numerical variations of voiding detrusor pressure and maximum pressure flowpre-operation and post-operation in both groups showed no statistical difference( P > 0. 05). Pre-operative ipsilateral vesicoureteric refluxes disappeared after the surgery. There wereno recurrence of bladder diverticula. The patients were asymptomatic in the followup. Conclusion There is no difference between the therapeutic effect of laparoscopic bladder diverticulectomy and open surgery. Laparoscopic bladder diverticulectomy is an ideal way of minimally invasive surgery,with small trauma and less bleeding.
Objective To compare the therapeutic effects of laparoscopic surgery and open surgery on primary bladder diverticula. Methods The data of 22 patients with primary bladder diverticula enrolled from September 2009 to July2016 were retrospectively reviewed. Twelve patients underwent open bladder diverticulectomy( open surgery group),ten patients underwent laparoscopic diverticulectomy( laparoscopy group). The operation time and operative hemorrhage of the two groups were compared with independent sample t test. The pre-operative and post-operative urodynamics were separately compared with paired-samples t test. The numerical variations of voiding detrusor pressure and maximum pressure flowin the two groups were compared with separate variance estimation t test. Results The operation time in laparoscopy group was longer than that in open surgery group( P < 0. 05). The operative hemorrhage in laparoscopy group was less than that in open surgery group( P < 0. 05). The follow-up time of open surgery group was( 13. 6 ±4. 0) months. The follow-up time of laparoscopy group was( 13. 6 ± 5. 7) months. The post-operative voiding detrusor pressure was lower than that in pre-operation in both groups( P < 0. 05). The maximum pressure flowincreased after the operation in both groups( P < 0. 05). Urine flowcurve was improved after the operation. The numerical variations of voiding detrusor pressure and maximum pressure flowpre-operation and post-operation in both groups showed no statistical difference( P > 0. 05). Pre-operative ipsilateral vesicoureteric refluxes disappeared after the surgery. There wereno recurrence of bladder diverticula. The patients were asymptomatic in the followup. Conclusion There is no difference between the therapeutic effect of laparoscopic bladder diverticulectomy and open surgery. Laparoscopic bladder diverticulectomy is an ideal way of minimally invasive surgery,with small trauma and less bleeding.
引文
[1]Psutka SP,Cendron M.Bladder diverticula in children[J].J Pediatr Urol,2013,9(2):129-138.
[2]宋宏程,赵学强,白继武,等.小儿先天性膀胱憩室[J].中华泌尿外科杂志,2007,28(12):816-818.SONG Hongcheng,ZHAO Xueqiang,BAI Jiw u,et al.Congenital bladder diverticula in children[J].Chin J Urol,2007,28(12):816-818.
[3]Khemakhem R,Ghorbel S,Jlidi S,et al.Management of congenital bladder diverticulum in children:a report of seven cases[J].Afr J Paediatr Surg,2013,10(2):160-163.
[4]Noh PH,Bansal D.Pediatric robotic assisted laparoscopy for paraureteral bladder diverticulum excision w ith ureteral reimplantation[J].J Pediatr Urol,2013,9(1):e28-30.
[5]Macedo A,Jr,Garrone G,Ottoni SL,et al.Primary congenital bladder diverticula:w here does the ureter drain?[J].Afr J Paediatr Surg,2015,12(4):280-285.
[6]Stephens FD.The vesicoureteral hiatus and paraureteral diverticula[J].J Urol,1979,121(6):786-791.
[7]Linke C,Mongiat-Artus P.Management of vesical diverticula[J].Ann Urol(Paris),2004,38(3):103-111.
[8]Pieretti RV,Pieretti-Vanmarcke RV.Congenital bladder diverticula in children[J].J Pediatr Surg,1999,34(3):468-473.
[9]Celebi S,Sander S,Kuzdan O,et al.Current diagnosis and management of primary isolated bladder diverticula in children[J].J Pediatr Urol,2015,11(2):61 e61-65.
[10]Alexander RE,Kum JB,Idrees M.Bladder diverticulum:clinicopathologic spectrum in pediatric patients[J].Pediatr Dev Pathol,2012,15(4):281-285.
[11]Azahouani A,Hida M,Lasseri A,et al.Acute retention of urine secondary to a congenital diverticulum of the bladder[J].Arch Pediatr,2016,23(10):1059-1062.
[12]Evangelidis A,Castle EP,Ostlie DJ,et al.Surgical management of primary bladder diverticula in children[J].J Pediatr Surg,2005,40(4):701-703.
[13]Karakus SC,Ceylan H,Ozokutan BH,et al.A bladder stone w ithin a congenital paraureteral diverticulum:a case report[J].Urology,2014,84(2):475-477.
[14]Miller M,Baker LA,Tannin G,et al.Lower extremity venous obstruction secondary to congenital bladder diverticulum[J].J Urol,2007,177(5):1891.
[15]Gaudet R,Heim N,Merviel P,et al.Prenatal diagnosis of a congenital bladder diverticulum.Case report and benefits of prenatal diagnosis[J].Fetal Diagn Ther,1999,14(5):301-305.
[16]Bhat A,Bothra R,Bhat MP,et al.Congenital bladder diverticulum presenting as bladder outlet obstruction in infants and children[J].J Pediatr Urol,2012,8(4):348-353.
[17]Porpiglia F,Tarabuzzi R,Cossu M,et al.Is laparoscopic bladder diverticulectomy after transurethral resection of the prostate safe and effective?Comparison w ith open surgery[J].J Endourol,2004,18(1):73-76.
[18]Marte A,Cavaiuolo S,Esposito M,et al.Vesicoscopic treatment of symptomatic congenital bladder diverticula in children:a 7-year experience[J].Eur J Pediatr Surg,2016,26(3):240-244.
[19]李关彬,王翰博,郭旭东,等.经腹腔路径腹腔镜输尿管膀胱角悬提吻合术治疗输尿管中下段长段狭窄的疗效[J].山东大学学报(医学版),2014,52(7):90-93.LI Guanbin,WANG Hanbo,GUO Xudong,et al.Laparoscopic bladdeconstr horn technique long-distance ureteral stenosis[J].Journal of Shandong University(Health Sciences),2014,52(7):90-93.
[20]Appeadu-Mensah W,Hesse AA,Yaw MB.Giant bladder diverticulum:a rare cause of bladder outlet obstruction in children[J].Afr J Paediatr Surg,2012,9(1):83-87.
[21]El Abiad Y,Bakloul F.Squamous cell carcinoma in a giant bladder diverticulum[J].Pan Afr M ed J,2015,20:378.
[22]Dong WX,Ping YX,Liang WC,et al.Small cell carcinoma of the urinary bladder diverticulum:a case report and review of the literature[J].J Cancer Res Ther,2013,9(1):151-153.
[23]Fu LY,Adeniran AJ.Adenocarcinoma Arising from a Bladder Diverticulum[J].J Urol,2015,194(2):527-528.
[24]Abou Ghaida RR,Saoud RM,Bulbul M.Primary osteosarcoma in a bladder diverticulum[J].Can J Urol,2014,21(4):7393-7395.
[25]Golijanin D,Yossepowitch O,Beck SD,et al.Carcinoma in a bladder diverticulum:presentation and treatment outcome[J].J Urol,2003,170(5):1761-1764.
[2]宋宏程,赵学强,白继武,等.小儿先天性膀胱憩室[J].中华泌尿外科杂志,2007,28(12):816-818.SONG Hongcheng,ZHAO Xueqiang,BAI Jiw u,et al.Congenital bladder diverticula in children[J].Chin J Urol,2007,28(12):816-818.
[3]Khemakhem R,Ghorbel S,Jlidi S,et al.Management of congenital bladder diverticulum in children:a report of seven cases[J].Afr J Paediatr Surg,2013,10(2):160-163.
[4]Noh PH,Bansal D.Pediatric robotic assisted laparoscopy for paraureteral bladder diverticulum excision w ith ureteral reimplantation[J].J Pediatr Urol,2013,9(1):e28-30.
[5]Macedo A,Jr,Garrone G,Ottoni SL,et al.Primary congenital bladder diverticula:w here does the ureter drain?[J].Afr J Paediatr Surg,2015,12(4):280-285.
[6]Stephens FD.The vesicoureteral hiatus and paraureteral diverticula[J].J Urol,1979,121(6):786-791.
[7]Linke C,Mongiat-Artus P.Management of vesical diverticula[J].Ann Urol(Paris),2004,38(3):103-111.
[8]Pieretti RV,Pieretti-Vanmarcke RV.Congenital bladder diverticula in children[J].J Pediatr Surg,1999,34(3):468-473.
[9]Celebi S,Sander S,Kuzdan O,et al.Current diagnosis and management of primary isolated bladder diverticula in children[J].J Pediatr Urol,2015,11(2):61 e61-65.
[10]Alexander RE,Kum JB,Idrees M.Bladder diverticulum:clinicopathologic spectrum in pediatric patients[J].Pediatr Dev Pathol,2012,15(4):281-285.
[11]Azahouani A,Hida M,Lasseri A,et al.Acute retention of urine secondary to a congenital diverticulum of the bladder[J].Arch Pediatr,2016,23(10):1059-1062.
[12]Evangelidis A,Castle EP,Ostlie DJ,et al.Surgical management of primary bladder diverticula in children[J].J Pediatr Surg,2005,40(4):701-703.
[13]Karakus SC,Ceylan H,Ozokutan BH,et al.A bladder stone w ithin a congenital paraureteral diverticulum:a case report[J].Urology,2014,84(2):475-477.
[14]Miller M,Baker LA,Tannin G,et al.Lower extremity venous obstruction secondary to congenital bladder diverticulum[J].J Urol,2007,177(5):1891.
[15]Gaudet R,Heim N,Merviel P,et al.Prenatal diagnosis of a congenital bladder diverticulum.Case report and benefits of prenatal diagnosis[J].Fetal Diagn Ther,1999,14(5):301-305.
[16]Bhat A,Bothra R,Bhat MP,et al.Congenital bladder diverticulum presenting as bladder outlet obstruction in infants and children[J].J Pediatr Urol,2012,8(4):348-353.
[17]Porpiglia F,Tarabuzzi R,Cossu M,et al.Is laparoscopic bladder diverticulectomy after transurethral resection of the prostate safe and effective?Comparison w ith open surgery[J].J Endourol,2004,18(1):73-76.
[18]Marte A,Cavaiuolo S,Esposito M,et al.Vesicoscopic treatment of symptomatic congenital bladder diverticula in children:a 7-year experience[J].Eur J Pediatr Surg,2016,26(3):240-244.
[19]李关彬,王翰博,郭旭东,等.经腹腔路径腹腔镜输尿管膀胱角悬提吻合术治疗输尿管中下段长段狭窄的疗效[J].山东大学学报(医学版),2014,52(7):90-93.LI Guanbin,WANG Hanbo,GUO Xudong,et al.Laparoscopic bladdeconstr horn technique long-distance ureteral stenosis[J].Journal of Shandong University(Health Sciences),2014,52(7):90-93.
[20]Appeadu-Mensah W,Hesse AA,Yaw MB.Giant bladder diverticulum:a rare cause of bladder outlet obstruction in children[J].Afr J Paediatr Surg,2012,9(1):83-87.
[21]El Abiad Y,Bakloul F.Squamous cell carcinoma in a giant bladder diverticulum[J].Pan Afr M ed J,2015,20:378.
[22]Dong WX,Ping YX,Liang WC,et al.Small cell carcinoma of the urinary bladder diverticulum:a case report and review of the literature[J].J Cancer Res Ther,2013,9(1):151-153.
[23]Fu LY,Adeniran AJ.Adenocarcinoma Arising from a Bladder Diverticulum[J].J Urol,2015,194(2):527-528.
[24]Abou Ghaida RR,Saoud RM,Bulbul M.Primary osteosarcoma in a bladder diverticulum[J].Can J Urol,2014,21(4):7393-7395.
[25]Golijanin D,Yossepowitch O,Beck SD,et al.Carcinoma in a bladder diverticulum:presentation and treatment outcome[J].J Urol,2003,170(5):1761-1764.