腹腔镜根治性膀胱全切除联合回肠原位新膀胱术对膀胱癌患者免疫功能和生活质量的影响

目的:探讨腹腔镜根治性膀胱全切除联合回肠原位新膀胱术对膀胱癌患者免疫功能和生活质量的影响。方法:选取2016年7月到2017年8月在我院进行治疗的膀胱癌患者90例,患者均采用根治性膀胱全切除联合回肠原位新膀胱术治疗,其中50例行开放性根治性膀胱全切除联合回肠原位新膀胱术,作为对照组;40例行腹腔镜根治性膀胱全切除联合回肠原位新膀胱术,作为观察组。记录患者围手术期指标及并发症,比较两组患者的尿动力学指标和免疫功能变化情况以及SF-36量表评分。结果:观察组患者的手术时间长于对照组,术中出血量、住院时间、胃肠功能恢复时间均短于对照组(P<0.05)。两组患者的膀胱容量、最大尿流率、充盈期膀胱压力、排尿时最大膀胱压、最大尿道压、残留尿量和总并发症发生率比较无差异(P>0.05)。术后3 d,两组患者的CD3^+、CD4^+、CD4^+/CD8^+水平均有所下降,CD8^+水平有所上升(P<0.05),且观察组的CD3^+、CD4^+、CD4^+/CD8^+水平高于对照组,CD8^+水平低于对照组(P<0.05)。术后1个月两组患者的生理职能、生理机能、健康状况、躯体疼痛、社会功能、精力、情感职能以及精神健康评分均有增加(P<0.05),且观察组的生理职能、健康状况、精力、情感职能以及精神健康评分明显高于对照组(P<0.05)。结论:与开放手术相比,腹腔镜根治性膀胱全切除联合回肠原位新膀胱术手术时间更长,但术中出血量少,患者术后恢复快,且手术对患者的免疫功能影响较小,可显著提升患者的生活质量。

Effect of Total Laparoscopic Radical Cystectomy Combined with Ileum in Situ Cystectomy on Immune Function and Quality of Life in Patients with Bladder Cancer

ABSTRACT Objective: To investigate the effect of total laparoscopic radical cystectomy combined with ileum in situ cystectomy on immune function and quality of life in patients with bladder cancer. Methods: 90 patients with bladder cancer who were treated in our hospital from July 2016 to August 2017 were selected, the patients were treated with radical cystectomy combined with ileum in situ cystectomy, 50 patients were treated with open radical cystectomy combined with ileum in situ cystectomy as a control group, 40 patients were treated with total laparoscopic radical cystectomy combined with ileum in situ cystectomy as a observation group. The perioperative indicators and complications of patients were recorded. The changes of urodynamic index and immune function in the two groups were compared, and the changes of the SF-36 scale score were also compared. Results: The operation time of the patients in the observation group was longer than that of the control group, the amount of intraoperative bleeding, the time of hospitalization and the recovery time of the gastrointestinal function were shorter than those in the control group (P<0.05). There were no significant difference in bladder volume, maximum urine flow rate, filling bladder pressure, maximum bladder pressure, maximum urethral pressure, residual urine volume and total complication rate between the two groups(P>0.05). 3 d after operation, the levels of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ decreased in the two groups, and the level of CD8⁺increased(P<0.05), the level of CD3⁺, CD4⁺ and CD4⁺/CD8⁺ in the observation group were higher than those of the control group, and the level of CD8⁺ was lower than that of the control group(P<0.05). 1 months after operation,the scores of physiological function, physical function, health status, physical pain, social function, energy, emotional function and mental health score between the two groups were increased(P<0.05), and the scores of physiological function, health status, energy, emotional function and mental health of the observation group were significantly higher than those of the control group (P<0.05). Conclusion: Compared with open surgery, the operation time of the patients with total laparoscopic radical cystectomy combined with ileum in situ cystectomy are longer, but the amount of intraoperative bleeding is less, the recovery time is shorter, and less influence on immune function by surgery. It can significantly improve the quality of life of patients, which is worthy of clinical promotion.