造瘘口切口辅助技术在腹腔镜膀胱根治性切除及回肠通道术中的应用

Application of the stoma incision-assisted technique in laparoscopic radical cystectomy and ileal conduit

摘要:

目的 探讨造瘘口切口辅助技术（通过造瘘口切口取标本，行肠吻合及输尿管吻合）在腹腔镜膀胱根治性切除及回肠通道术中的安全性、实用性。方法 将60例需行膀胱根治性切除及回肠通道术的患者随机分为造瘘口切口辅助技术组（试验组）及传统下腹正中切口辅助技术组（对照组），比较2组患者尿流改道手术时间、术中出血量、并发症发生率、术后住院日、术后疼痛评分的差异。结果 试验组尿流改道手术时间少于对照组［（105.0±18.9） min vs. （117.0±17.7） min，P<0.05］；术后疼痛评分低于对照组（4.03±1.50 vs. 5.40±1.69，P<0.05）；术后住院时间少于对照组［（8.27±1.86） d vs.（9.70±1.87） d，P<0.05］；术中出血量2组间差异无统计学意义［试验组：（260±155） mL，对照组：（271±154） mL，P=0.784］。试验组并发症发生4例，其中2例为肠梗阻，1例造瘘口旁疝，1例尿路感染；对照组并发症发生6例，其中肠梗阻3例，切口感染2例，尿路感染1例。组间总体并发症发生率无明显统计学差异。结论 造瘘口切口辅助技术应用于腹腔镜膀胱根治性切除及回肠通道术安全可行，在术后快速康复中有良好的应用前景。

Abstract:

Objective To investigate the safety and practicability of the stoma incision-assisted technique （sampling specimens and performing intestinal anastomosis and ureteral anastomosis through the stoma incision） in laparoscopic radical cystectomy and ileal conduit.Methods In this study，60 patients who had an indication for radical cystectomy or ileal conduit were randomly divided into stoma incision-assisted technique group（experimental group） and traditional lower midline abdominal incision-assisted technique group（control group）. The two groups were compared for urinary diversion operation time，intraoperative blood loss，complication rate，length of postoperative hospital stay，and postoperative pain score.Results The urinary diversion operation time was significantly shorter in the experimental group than in the control group［（105.0±18.9） min vs. （117.0±17.7） min，P<0.05］. The postoperative pain score was significantly lower in the experimental group than in the control group （4.03±1.50 vs. 5.40±1.69，P<0.05）. The length of postoperative hospital stay was significantly shorter in the experimental group than in the control group［（8.27±1.86） days vs. （9.70±1.87） days，P<0.05］. There was no significant difference between the two groups in intraoperative blood loss［experimental group：（260±155） mL，control group：（271±154） mL，P=0.784］. Four cases in the experimental group experienced complications （intestinal obstruction in 2 cases，parastomal hernia in 1 case，and urinary tract infection in 1 case）. Six cases in the control group experienced complications （intestinal obstruction in 3 cases，incision infection in 2 cases，and urinary tract infection in 1 case）. There was no significant difference between the groups in overall complication rate.Conclusion It is safe and feasible to apply the stoma incision-assisted technique in laparoscopic radical cystectomy and ileal conduit，offering a promising application prospect for fast recovery after surgery.