| Purpose:The long-term quality of life of patients undergoing radical cystectomy(RC)and ileal orthotopic neobladder(NB)and ileal conduit(IC)were assessed by the FACT-BL,and the effects of different urinary diversion(UD)on the health-related quality of life(HRQo L)were compared to provide reference for surgeons and patients with radical cystectomy to choose UD,which is beneficial to the recovery of various functions and improve the quality of life.Methods:The study included 158 patients who received NB and IC after RC in urology department of the second hospital of Tianjin Medical University from January 2007 to January 2015.With the consent of the patients themselves and their families,the questionnaire survey of basic information and operation related information was conducted before and after the operation,and the FACT-BL was completed in the follow-up period of 1,3 and 5 years.The long-term dynamic quality of life of the two ways of UD were compared through the statistical analysis of transverse and longitudinal between and within the groups.In addition,the quality of life of 71 patients with two kinds of UD under laparoscope from February 2015 to December2018 was evaluated in one and three years after operation.The mean ± standard deviation(± s)indicates the measurement data,the chisquare test compares the inter group rate,the single sample t test compares the inter group mean,and the test level is P=0.05.Use Spss-21.0 and Microsoft Office Excel2016 to analyze and chart all data.Results:A total of 158 patients completed 5 years of follow-up,including 95 IC(73 men and 22 women)and 63 NB(49 men and 14 women).No significant difference between the two groups in sex ratio,average age at operation,tumor stage and preoperative HRQo L score(P > 0.05).The average hospitalization time of NB(28.4 ±7.8 days)was longer than IC(21.7 ± 6.3 days)(P < 0.05).The HRQo L score of NB increased year by year,and the IC tended to be stable.The two groups were close at 1and 3 years after operation.But the NB(125.8 ± 7.2)were significantly higher than the IC(108.9 ± 9.2)(P = 0.032),especially in the functional well-being(FWB)and bladder cancer subscale(BCS).Similar results were observed in the cases from February 2015 to December 2018.However,due to the concept of early rapid rehabilitation,the development of modern minimally invasive technology,the improvement of denippled and the application of new urine collection bags,IC’s HRQOL has a positive impact.Conclusion:IC and NB are the most commonly used ways of UD after RC.Our results show that there is no significant difference between them in the early.The IC tends to be stable,mainly due to poor physical condition,worry about nighttime urine collection bags and psychological barriers to integration into society.The physical condition of NB is closer to physiological signs.But in the early,exercise needs to be used to restore voluntary urination function.Over time,urinary control and voiding function improved significantly,social function performed better,and physical condition closer to physiological function,and long-term quality of life advantage was obvious.Therefore,the UD needs to be individualized,and the NB should be preferred when the opinions of the patients and their families,the life expectancy of the patients and the surgeons are good at the operation method are fully considered. |
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