Clinical Efficacy And Quality Of Life Of Laparoscopic Radical Cystectomy And Urinary Diversion

Objective:To explore the clinical application of laparoscopic radical cystectomy(LRC)plus small incision assisted urinary diversion and to summarize the experience.To compare the incidence of complications and health-related quality of life(HRQOL)after ileal conduit(IC)and orthotopic ileal neobladder(ON).Methods:The clinical data of 42 patients with bladder cancer who received LRC plus small incision assisted urinary diversion during July 2015 and December 2020 in our hospital were retrospectively analyzed.The operation methods and techniques,incidence and treatment of postoperative complications were introduced.At the same time,HRQOL scores were collected before and after the operation(1-12 months).Results:All operations were successfully completed without conversion to open surgery.There were 31 cases of IC and 11 cases of ON in situ.Short-term complications(<30 days)occurred in 11 cases(26.19%),including Intestinal fistula(Clavien-Dindo III-b)in 1case,intestinal obstruction(Clavien-Dindo Ⅱ)in 6 cases,lympholeakage(Clavien-Dindo I)in 3 cases,and myocardial infarction(Clavien-Dindo V)in 1 case.Long-term complications(≥30 days)occurred in 7 cases(16.67%),including mild hydronephrosis of left kidney(Clavien-Dindo I)in 1 case,acute pyelonephritis(Clavien-Dindo I)in 3 cases,granuloma bleeding of stoma mucosa(Clavien Dindo grade I)in 2 case,report Ileal mucosal prolapse(Clavien Dindo II)in 1 case,The volume of orthotopic neobladder was(350±85)ml,The mean volume of on was 350 ± 85 ml.all patients had normal diurnal urinary control,and 4(36.36%)had mild incontinence at night(0-1 urinary pad).There was no significant difference in the incidence of postoperative complications between ON group and IC group(P>0.05).Compared with the HRQOL scores of patients undergoing orthotopic neobladder(ON)and ileal conduit(IC),there was no significant difference in the HRQOL scores between ON group and IC group before operation(P>0.05);At 12 months after operation,the scores of functional status(FWB),bladder specific module(BSS)and FACT-BL in ON group were higher than those in IC group(P < 0.05).Conclusion:LRC plus small incision assisted urinary diversion is safe,effective and minimally invasive.Under the premise of strict screening for patients,ON may have more advantages than IC in HRQOL.However,due to the small sample size and short follow-up time in this study,it needs to be further confirmed by prospective large sample experiments and long-term follow-up.