Efficacy and safety analysis of cutaneous ureterostomy after single port plus one laparoscopic radical cystectomy
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摘要: 目的 对比分析单孔加一腹腔镜与传统腹腔镜根治性膀胱切除后输尿管皮肤造口术的临床疗效及安全性。方法 回顾性分析2019年4月—2024年3月在南方医科大学第三附属医院行根治性膀胱切除后输尿管皮肤造口术的22例膀胱癌患者的临床资料，其中单孔加一腹腔镜组10例，传统腹腔组12例。对2组患者围手术期资料、手术并发症以及术后随访情况进行对比分析。结果 所有患者均顺利完成手术，术中未出现中转开放手术，无围手术期死亡。2组患者临床资料在年龄、性别等方面比较差异均无统计学意义(P>0.05)。单孔加一腹腔镜组平均手术时间为(342.0±113.1) min，传统腹腔镜组平均手术时间为(292.8±63.5) min；单孔加一腹腔镜组术中出血量为(250.0±141.4) mL，传统腹腔镜组术中出血量为(312.5±143.2) mL，2组比较差异无统计学意义(P < 0.05)。而单孔加一腹腔镜组在术后疼痛视觉模拟评分(VAS)、术后离床活动时间、术后切口满意度评分方面优于传统腹腔镜组，差异有统计学意义(P < 0.05)。结论 单孔加一腹腔镜根治性膀胱切除术后输尿管皮肤造口术是安全可行的，术后患者恢复快、切口美观、满意度好。Abstract: Objective To explore the clinical efficacy and safety between single port plus one laparoscopic surgery and traditional laparoscopic radical cystectomy with cutaneous ureterostomy.Methods The clinical data of 22 patients with bladder cancer who underwent radical cystectomy followed by cutaneous ureterostomy in Third Affiliated Hospital of Southern Medical University from April 2019 to March 2024 were retrospectively analyzed. The patients were divided into single port plus one laparoscopic and traditional laparoscopic group. Perioperative data, surgical complications, and postoperative follow-up between two groups of these patients were compared and analyzed.Results All patients were successfully completed the surgery, without conversion to open surgery or perioperative mortality. There was no statistically significant difference in clinical data between the two groups of patients in terms of age, gender(P>0.05). The average surgical time for the single port plus one laparoscopic group was (342.0±113.1) min, while the average surgical time for the traditional laparoscopic group was (292.8±63.5) min. The intraoperative blood loss in the single port plus one laparoscopic group was (250.0±141.4) mL, and that in the traditional laparoscopic group was (312.5±143.2) mL. There was no statistically significant difference between the two groups(P < 0.05). The single port plus one laparoscopic group showed better postoperative VAS pain score, postoperative time to move out of bed, and postoperative incision satisfaction score than the traditional laparoscopic group, with statistical significance(P < 0.05).Conclusion Single port plus one laparoscopic radical cystectomy with cutaneous ureterostomy is safe and feasible, with fast postoperative recovery, beautiful incision, and good satisfaction for patients.
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表 1 2组患者术前一般特征数据比较
例(%)，M(P25，P75) 项目 单孔加一腹腔镜组(10例) 传统腹腔镜组(12例) P值 年龄/岁 73.5(65.3，76.3) 68.5(65.0，75.5) 0.658 性别 0.714 男 9(90.0) 11(91.7) 女 1(10.0) 1(8.3) BMI/(kg/m2) 22.2(19.0，24.5) 22.6(20.3，25.8) 0.648 既往腹部手术史 2(20.0) 1(8.3) 0.427 高血压 8(80.0) 11(91.7) 0.427 2型糖尿病 8(80.0) 9(75.0) 0.781 冠心病(PCI术后) 7(70.0) 8(66.7) 0.867 陈旧性脑梗死 5(50.0) 5(41.7) 0.696 
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表 2 2组患者术中及术后观察指标比较
例(%)，X±S 指标 单孔加一腹腔镜组(10例) 传统腹腔镜组(12例) P值 手术时长/min 342.0±113.1 292.8±63.5 0.241 术中出血量/mL 250.0±141.4 312.5±143.2 0.317 术中输血 4(40.0) 5(41.7) 0.639 VAS评分/分 4.0±1.1 5.9±0.8 < 0.001 术后离床活动时间/h 24.2±10.1 36.8±9.4 < 0.001 清扫淋巴结数/个 18.4±5.4 18.3±4.1 0.975 淋巴结阳性 2(20.0) 3(25.0) 0.781 术后3个月输尿管支架相关并发症 3(30.0) 7(58.3) 0.231 肾盂肾炎 1(10.0) 3(25.0) 支架管脱落 1(10.0) 1(8.3) 支架管梗阻 1(10.0) 2(16.7) 造口周围刺激性皮炎 0(0) 1(8.3) 输尿管吻合口狭窄 0(0) 0(0) 术后切口满意度评分/分 4.5±0.5 2.8±0.7 < 0.001
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