Comparison of the complications and quality of life between ileal conduit and cutaneous ureterostomy after laparoscopic radical cystectomy
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摘要: 目的比较腹腔镜膀胱全切术后与不可控尿流改道术，即回肠流出道术(IC)及输尿管皮肤造口术(CU)相关的术后并发症发生情况及生活质量。方法回顾性纳入2020年11月—2022年3月于四川大学华西医院接受腹腔镜膀胱全切术和后续不可控尿流改道术的77例患者，其中IC组56例，CU组21例。随访术后早期及晚期并发症的发生情况及生存质量状况，通过t检验、Mann-Whitney U检验和χ2检验及其校正公式来比较两组间的差异。通过EQ-5D-3L问卷评估患者术后生活质量。结果腹腔镜膀胱全切术后接受不可控尿流改道术的患者中，CU组伴肾功能不全(28.6% vs.5.4%)和尿路感染(28.6% vs.5.4%)的患者比例均显著高于IC组(均P < 0.05)。IC组和CU组术后早期并发症发生率均为28.6%，术后晚期并发症发生率分别为19.6%与23.8%，两组术后早、晚期并发症发生率均差异无统计学意义。两组术后生活质量差异无统计学意义。结论在腹腔镜膀胱全切术后，CU更倾向于被应用在身体状况较差的患者群体，其围术期、术后并发症及生活质量方面与IC比较没有显著劣势，因此CU仍可作为一种可推荐的不可控尿流改道术式。
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关键词:
- 腹腔镜根治性膀胱切除术 /
- 回肠通道术 /
- 输尿管皮肤造口术 /
- 并发症 /
- 生活质量
Abstract: ObjectiveTo compare the postoperative complications and quality of life associated with urinary diversion between cutaneous ureterostomy(CU) and ileal conduit(IC) after laparoscopic radical cystectomy.MethodsThis retrospective study included 77 patients with bladder cancer who underwent laparoscopic radical cystectomy and subsequent CU(n=21) and IC(n=56) at West China Hospital, Sichuan University from November 2020 to March 2022. The incidence of early and late postoperative complications and quality of life were followed up, and the differences between the two groups were compared using t-test, Mann-Whitney U test, Chi-Square test and the correction formula. The EQ-5D-3L questionnaire was used to assess the patients'postoperative quality of life.ResultsAmong patients with bladder cancer who underwent laparoscopic radical cystectomy and subsequent urinary diversion, the proportions of patients with renal dysfunction(28.6% vs. 5.4%) and urinary tract infection(28.6% vs. 5.4%) in the CU group were significantly higher than those in the IC group(both P < 0.05). The incidence of early postoperative complications in the IC group and CU group were 28.6%, respectively, and the late complications rate were 19.6% in the IC group and 23.8% in the CU group. There were no significant differences in the incidence of early and late postoperative complications or quality of life between the two groups.ConclusionAfter laparoscopic radical cystectomy, CU tends to be operated in patients with poor physical condition, and its perioperative, postoperative complications and quality of life are not significantly inferior to IC. Thus CU can still be used as a recommended uncontrolled urinary flow diversion. -
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表 1 患者基本情况
X±S 项目 IC组(56例) CU组(21例) P值 年龄/岁 63.45±11.33 68.62±10.08 0.070 性别/例(%) 0.627 男 43(76.8) 13(71.4) 女 15(23.2) 6(28.6) BMI/(kg·m-2) 23.38±3.17 22.19±3.44 0.157 术前肌酐/(μmol·L-1) 89.88±39.75 159.48±184.39 0.010 术前血红蛋白/(g·L-1) 118.62±22.77 125.36±24.48 0.219 术前白细胞/(×109·L-1) 6.43±2.18 6.80±2.13 0.504 并发症/例(%) 高血压 14(25.0) 5(23.8) 0.914 糖尿病 11(19.6) 4(19.0) 1.000 冠心病 1(1.8) 1(4.8) 1.000 心律失常 1(1.8) 2(9.5) 0.367 肾积水 7(12.5) 4(19.0) 0.715 肾功能不全 3(5.4) 6(28.6) 0.015 尿路感染 3(5.4) 6(28.6) 0.015 肝脏相关疾病 3(5.4) 1(4.8) 1.000 脑血管疾病 4(7.1) 0(0) 0.570 呼吸系统相关疾病 8(14.3) 2(9.5) 0.863 T分级/例(%) 0.525 T1或Tis 18(32.1) 4(19.0) T2 15(26.8) 6(28.6) T3 18(32.1) 7(33.3) T4 5(8.9) 4(19.0) ASA分级/例(%) 0.136 Ⅱ级 32(57.1) 8(38.1) Ⅲ级 24(42.9) 13(61.9) 注：Tis：原位癌；ASA：美国麻醉医师协会。 
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表 2 腹腔镜膀胱全切术后两组患者早期并发症
例(%) 并发症 IC组(56例) CU组(21例) P值 伤口感染 2(3.6) 2(9.5) 0.637 伤口裂开 1(1.8) 0(0) 1.000 尿路感染 3(5.4) 0(0) 0.674 低蛋白血症 2(3.6) 1(4.8) 1.000 周围神经病变 2(3.6) 0(0) 0.942 肠梗阻 3(5.4) 2(9.5) 0.887 淋巴囊肿 2(3.6) 0(0) 0.942 肺炎 1(1.8) 0(0) 1.000 深静脉血栓 0(0) 1(4.8) 0.607 并发症总例数 16(28.6) 6(28.6) 1.000
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表 3 腹腔镜全切术后两组患者晚期并发症
例(%) 并发症 IC组(56例) CU组(21例) P值 伤口感染 5(8.9) 1(4.8) 0.896 尿路感染 2(3.6) 0(0) 0.942 肠梗阻 1(1.8) 1(4.8) 1.000 周围神经病变 1(1.8) 1(4.8) 1.000 淋巴囊肿 2(3.6) 0(0) 0.942 造口旁疝 1(1.8) 1(4.8) 1.000 上尿路梗阻 1(1.8) 1(4.8) 1.000 并发症总例数a) 11(19.6) 5(23.8) 0.688 注：a)若同1例患者同时存在2种及以上并发症时，仍只计为1例。
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表 4 ITPW及PSM处理后组间数据比较
X±S 项目 PSM处理后 ITPW处理后 IC组(13例) CU组(13例) P值 IC组(50.66例) CU组(19.33例) P值 年龄/岁 67.08±12.91 66.77±10.57 0.948 63.85±11.26 63.37±10.71 0.866 性别/例(%) 0.277 0.541 男 12 (92.31) 10 (76.92) 38.30(75.60) 13.24(68.50) 女 1 (7.69) 3 (23.08) 12.36(24.40) 6.09(31.50) BMI/(kg·m-2) 24.00±3.18 23.46±3.22 0.667 23.45±3.01 24.12±3.86 0.489 术前肌酐/(μmol·L-1) 110.46±28.08 108.08±30.70 0.838 94.61±45.26 120.35±107.15 0.310 术前血红蛋白/(g·L-1) 119.15±33.35 119.15±25.45 1.000 125.08±25.96 125.90±19.70 0.886 T分级/例(%) 0.338 0.921 T1或Tis 4 (30.77) 3 (23.08) 15.30(30.20) 7.46(38.60) T2 1 (7.69) 4 (30.77) 12.82(25.30) 4.18(21.60) T3 5 (38.46) 2 (15.39) 16.26(32.10) 5.33(27.60) T4 3 (23.08) 4 (30.77) 6.28(12.40) 2.36(12.20) ASA分级/例(%) 0.695 0.828 Ⅱ级 7 (53.85) 6 (46.15) 26.39(52.10) 9.45(48.90) Ⅲ级 6 (46.15) 7 (53.85) 24.27(46.50) 9.88(51.10) 生活质量总评分 0.70±0.10 0.75±0.12 0.873 注：经ITPW处理后的患者例数不为整数，此处保留该处理结果以供参考。
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表 5 EQ-5D-3L问卷信息总结
例(%) 项目 程度分级 P值 1 2 3 术后活动 0.230 IC组(56例) 45(80.4) 9(16.1) 2(3.6) CU组(21例) 13(61.9) 7(33.3) 1(4.8) 自我照顾 0.462 IC组(56例) 44(78.6) 11(19.6) 1(1.8) CU组(21例) 18(85.7) 2(9.5) 1(4.8) 日常活动 0.707 IC组(56例) 43(76.8) 9(16.1) 4(7.1) CU组(21例) 15(71.4) 5(23.8) 1(4.8) 不适程度 0.734 IC组(56例) 43(76.8) 12(21.4) 1(1.8) CU组(21例) 15(71.4) 5(23.8) 1(4.8) 心情指数 0.144 IC组(56例) 35(62.5) 19(33.9) 2(3.6) CU组(21例) 14(66.7) 4(19.0) 3(14.3)
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