不同尿流改道方式对行腹腔镜膀胱癌根治术后男性患者生活质量和性功能的影响
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摘要
目的:探讨不同尿流改道方式对行腹腔镜膀胱癌根治术后男性患者生活质量和性功能的影响。方法:将260例接受腹腔镜膀胱癌根治术和尿流改道术男性患者根据尿流改道术式不同分为两组,130例患者接受原位回肠新膀胱术(新膀胱组),130例患者接受回肠膀胱术(回肠膀胱组)。对比两组手术资料及术后近远期并发症情况,分析两组术后生活质量及性功能状况。结果:新膀胱组在手术时间、肠功能恢复时间和住院时间均明显长于回肠膀胱组(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。新膀胱组患者术后生理职能、生理功能、社会功能、情感职能和心理健康评分均明显高于回肠膀胱组(P<0.05)。新膀胱组患者治疗后IIEF-5评分明显高于回肠膀胱组,ASEX评分则显著低于回肠膀胱组(P<0.05)。结论:原位回肠新膀胱术虽然操作难度高,但其能够保留正常排尿功能,对患者术后生活质量和性功能的影响较小,可作为腹腔镜膀胱癌根治术后男性患者尿流改道的首选术式。
Objective:To explore the effect of different urinary diversions on life quality and sexual function in male patients undergoing laparoscopic radical surgery for bladder cancer.Methods:260 patients underwent laparoscopic radical cystectomy and urinary diversions were divided into two groups. 130 patients in neobladder group were given orthotopic ileal neobladder operation,and 130 patients in Bricker group received Bricker operation. The surgical data and postoperative complications were compared between the two groups. The postoperative living quality and sexual function of two groups were analyzed.Results:The operation time,intestinal function recovery and hospitalization time in neobladder group were significantly longer than that in Bricker group(P<0.05). There was no significant difference in incidence of postoperative complications between two groups(P>0.05). The scores of physiological role,physiological function,social function,emotional function and mental health in neobladder group were significantly higher than those in Bricker group(P<0.05). After treatment,the IIEF-5 score of neobladder group was significantly higher than that of Bricker group,while the ASEX score was significantly lower than Bricker group(P<0.05).Conclusion:Although orthotopic ileal neobladder operation is a complicated procedure,it reserves normal urinary function and has small effect on postoperative quality of life and sexual function,and can be used as a preferred surgical method.
Objective:To explore the effect of different urinary diversions on life quality and sexual function in male patients undergoing laparoscopic radical surgery for bladder cancer.Methods:260 patients underwent laparoscopic radical cystectomy and urinary diversions were divided into two groups. 130 patients in neobladder group were given orthotopic ileal neobladder operation,and 130 patients in Bricker group received Bricker operation. The surgical data and postoperative complications were compared between the two groups. The postoperative living quality and sexual function of two groups were analyzed.Results:The operation time,intestinal function recovery and hospitalization time in neobladder group were significantly longer than that in Bricker group(P<0.05). There was no significant difference in incidence of postoperative complications between two groups(P>0.05). The scores of physiological role,physiological function,social function,emotional function and mental health in neobladder group were significantly higher than those in Bricker group(P<0.05). After treatment,the IIEF-5 score of neobladder group was significantly higher than that of Bricker group,while the ASEX score was significantly lower than Bricker group(P<0.05).Conclusion:Although orthotopic ileal neobladder operation is a complicated procedure,it reserves normal urinary function and has small effect on postoperative quality of life and sexual function,and can be used as a preferred surgical method.
引文
[1]SIDDIQUI KM,IZAWA JI.Ileal conduit:standard urinary diversion for elderly patients undergoing radical cystectomy.World J Urol,2016,34(1):19-24.
[2]林晨,刘湘鄂,向俊,等.吡柔比星膀胱灌注对浅表性膀胱癌患者血清sICAM-1,VEGF及MMP-9水平的影响.微创泌尿外科杂志,2018,7(5):346-350.
[3]符仕宝,方茜茜,何书明,等.膀胱癌患者微创切除术后不同尿流改道方案的临床效果对比.中国内镜杂志,2017,23(6):66-70.
[4]何金祥,于德新,毕良宽.腹腔镜下膀胱根治性切除术后2种尿流改道术式的近期并发症比较.安徽医学,2017,38(6):685-688.
[5]吴岑,苏仲宁,伍伯聪,等.腹腔镜根治性全膀胱切除+原位回肠新膀胱术对膀胱癌患者的临床疗效及并发症分析.国际泌尿系统杂志,2016,36(4):481-484.
[6]邱志磊,牛海涛,孙光.2005年欧洲泌尿外科会议膀胱癌诊断治疗纲要.临床泌尿外科杂志,2006,21(4):318-320.
[7]李春波,何燕玲.健康状况调查问卷SF-36的介绍.国外医学(精神病学分册),2002,29(2):116-119.
[8]MCGAHUEY CA,GELENBERG AJ,LAUKESCA,et al.The Arizona sexual experience scale(ASEX):reliability and validity.J Sex Marital Ther,2000,26(1):25-40.
[9]ROSEN RC,RILEY A,WAGNER G,et al.The international index of erectile function(IIEF):a multidimensional scale for assessment of erectile dysfunction.Urology,1997,49(6):822-830.
[10]李信,王明,何卫阳,等.膀胱全切不同尿流改道术后生活质量的比较.重庆医科大学学报,2016,41(2):201-204.
[11]胡淼,顾朝辉,贾占奎,等.腹腔镜根治性膀胱切除术后不同尿流改道术式疗效比较.中华实验外科杂志,2016,33(3):804-806.
[12]王哲,陈怀安,张潮,等.全膀胱切除术不同尿流改道方式的效果及预后.中国中西医结合外科杂志,2017,23(5):499-502.
[13]毛士玉,黄天宝,熊大波,等.膀胱全切Bricker术与Studer原位膀胱术8年的随访和评价.现代泌尿外科杂志,2016,21(3):170-173.
[14]何俊,王海峰,王剑松.国内全膀胱切除术后不同尿流改道术式临床疗效的Meta分析.现代泌尿外科杂志,2016,21(11):828-833.
[15]徐宝海,余义,熊丙健.膀胱癌根治性全膀胱切除术后三种不同尿流改道方式的临床疗效及对患者生活质量的影响.解放军医药杂志,2018,30(9):20-23.
[16]倪锋,杜永辉,郑亮,等.不同尿流改道方案在肌层浸润性膀胱癌微创手术患者中的应用效果.中国肿瘤临床与康复,2017,24(9):1097-1100.
[17]肖亚军,张龙.根治性膀胱切除术及尿流改道的认知及体会.临床泌尿外科杂志,2016,31(5):393-397.
[18]GOLDBERG H,BANIEL J,MANO R,et al.Orthotopic neobladder vs.ileal conduit urinary diversion:A long-term quality-of-life comparison.Urol Oncol,2016,34(121):e1-e7.
[19]YANG LS,SHAN BL,SHAN LL,et al.A systematic review and meta-analysis of quality of life outcomes after radical cystectomy for bladder cancer.Surg Oncol,2016,25(3):281-297.
[20]RUBENWOLF P,THOMAS C,THUEROFF JW.Sexual function,social integration and paternity of males with classic bladder exstrophy following urinary diversion.J Urol,2016,195(2):465-470.
[21]SINGH V,YADAV R,SINHA RJ,et al.Prospective comparison of quality-of-life outcomes between ileal conduit urinary diversion and orthotopic neobladder Reconstruction after radical cystectomy:a statistical model.BJU Int,2014,113(5):726-732.
[22]HEDGEPETH RC,GILBERT SM,HE C,et al.Body image and bladder cancer specific quality of life in patients with ileal conduit and neobladder urinary diversions.Urology,2010,76(3):671-675.
[2]林晨,刘湘鄂,向俊,等.吡柔比星膀胱灌注对浅表性膀胱癌患者血清sICAM-1,VEGF及MMP-9水平的影响.微创泌尿外科杂志,2018,7(5):346-350.
[3]符仕宝,方茜茜,何书明,等.膀胱癌患者微创切除术后不同尿流改道方案的临床效果对比.中国内镜杂志,2017,23(6):66-70.
[4]何金祥,于德新,毕良宽.腹腔镜下膀胱根治性切除术后2种尿流改道术式的近期并发症比较.安徽医学,2017,38(6):685-688.
[5]吴岑,苏仲宁,伍伯聪,等.腹腔镜根治性全膀胱切除+原位回肠新膀胱术对膀胱癌患者的临床疗效及并发症分析.国际泌尿系统杂志,2016,36(4):481-484.
[6]邱志磊,牛海涛,孙光.2005年欧洲泌尿外科会议膀胱癌诊断治疗纲要.临床泌尿外科杂志,2006,21(4):318-320.
[7]李春波,何燕玲.健康状况调查问卷SF-36的介绍.国外医学(精神病学分册),2002,29(2):116-119.
[8]MCGAHUEY CA,GELENBERG AJ,LAUKESCA,et al.The Arizona sexual experience scale(ASEX):reliability and validity.J Sex Marital Ther,2000,26(1):25-40.
[9]ROSEN RC,RILEY A,WAGNER G,et al.The international index of erectile function(IIEF):a multidimensional scale for assessment of erectile dysfunction.Urology,1997,49(6):822-830.
[10]李信,王明,何卫阳,等.膀胱全切不同尿流改道术后生活质量的比较.重庆医科大学学报,2016,41(2):201-204.
[11]胡淼,顾朝辉,贾占奎,等.腹腔镜根治性膀胱切除术后不同尿流改道术式疗效比较.中华实验外科杂志,2016,33(3):804-806.
[12]王哲,陈怀安,张潮,等.全膀胱切除术不同尿流改道方式的效果及预后.中国中西医结合外科杂志,2017,23(5):499-502.
[13]毛士玉,黄天宝,熊大波,等.膀胱全切Bricker术与Studer原位膀胱术8年的随访和评价.现代泌尿外科杂志,2016,21(3):170-173.
[14]何俊,王海峰,王剑松.国内全膀胱切除术后不同尿流改道术式临床疗效的Meta分析.现代泌尿外科杂志,2016,21(11):828-833.
[15]徐宝海,余义,熊丙健.膀胱癌根治性全膀胱切除术后三种不同尿流改道方式的临床疗效及对患者生活质量的影响.解放军医药杂志,2018,30(9):20-23.
[16]倪锋,杜永辉,郑亮,等.不同尿流改道方案在肌层浸润性膀胱癌微创手术患者中的应用效果.中国肿瘤临床与康复,2017,24(9):1097-1100.
[17]肖亚军,张龙.根治性膀胱切除术及尿流改道的认知及体会.临床泌尿外科杂志,2016,31(5):393-397.
[18]GOLDBERG H,BANIEL J,MANO R,et al.Orthotopic neobladder vs.ileal conduit urinary diversion:A long-term quality-of-life comparison.Urol Oncol,2016,34(121):e1-e7.
[19]YANG LS,SHAN BL,SHAN LL,et al.A systematic review and meta-analysis of quality of life outcomes after radical cystectomy for bladder cancer.Surg Oncol,2016,25(3):281-297.
[20]RUBENWOLF P,THOMAS C,THUEROFF JW.Sexual function,social integration and paternity of males with classic bladder exstrophy following urinary diversion.J Urol,2016,195(2):465-470.
[21]SINGH V,YADAV R,SINHA RJ,et al.Prospective comparison of quality-of-life outcomes between ileal conduit urinary diversion and orthotopic neobladder Reconstruction after radical cystectomy:a statistical model.BJU Int,2014,113(5):726-732.
[22]HEDGEPETH RC,GILBERT SM,HE C,et al.Body image and bladder cancer specific quality of life in patients with ileal conduit and neobladder urinary diversions.Urology,2010,76(3):671-675.