| Objective:To discuss the clinical efficacy betweenmodified radical cystectomy orthotopic ileal neobladder and radicalcystectomy Bricker operation among the patients who underwent bladdercancer,and find out which is the better way in the two urinary diversionsand provide some clinical suggestions. Methods:The clinical data of thestudy subjects40bladder cancer patients after radical cystectomy, wereretrospectively analyzed, including24with modified radical cystectomyorthotopic ileal neobladder group (OIN group) and16with radicalcystectomy Bricker operation group(BO group). Parameters associatedwith the general clinical information and clinical efficacy of the patients,including age, along with the diseases, clinical stage and pathologicalgrade,the positive rate of lymph node, the amount of bleeding duringoperation,operation time,the hospital stays,postoperative complications,the rate of perioperative mortality and reoperation,the rate of recurrenceand survival were compared and analyzed between the two groups. Thehealth related quality of life was analyzed and assessed using FuctionalAssessment of Cancer Therapy-Bladder Cancer (FACT-BL)questionnaires by reviewing and inviting the patients to our department.Results:In the aspect of clinical data,there were no statistical differencesbetween OIN group and BO group on age，along with the diseases,clinical stage and pathological grade, the rate of perioperative mortality and reoperation,the positive rate of lymph node(P>0.05).OIN group andBO group had significant differences in operation time (391.04±62.78minand314.38±43.5min), the amount of bleeding during operation(1110.42±59.46ml vs871.87±246.85ml), hospital stays(34.13±6.12d and28.43±5.80d), these differences had statistical significances (P<0.05).Theincidence of urinary tract infection in OIN group and BO group wascompared (8.33%vs37.5%),this difference was statistical significant (P<0.05).There were no statistical significances in the incidence of otheraspects in postopertaion complication,including partial ileus (8.33%vs6.25%), pulmonary infection (4.17%vs0%), incision split (4.17%vs0%),urinary leakage (12.5%vs6.25%), outlet obstruction (8.33%vs6.5%)between OIN group and BO group patients(P>0.05). OIN group and BOgroup in the aspects of the1-year tumor recurrence rate (0%vs0%) andsurvival rate (100%vs100%),3-year tumor recurrence rate (0vs6.25%)and survival rate (95.83%vs93.75%) respectively had no statisticaldifferences(P>0.05).There were no statistical significances insocial/family well-being(SWB)(21.77±1.20points vs21.3±1.86points)and emotional well-being(EWB)(20.27±2.14points vs19.5±1.45points）between OIN group and BO group(P>0.05).OIN group gotsignificantly higher scores in physical well-being (PWB)(22±1.98pointsvs20.57±1.34points), functional well-being (FWB)(21.59±2.15points vs17.64±1.86points),overall bladder special subscale(BSS)（33.77±2.71points vs28.57±2.44points), FACT-G（85.64±4.16points vs79.07±3.27 points）and FACT-BL（119.41±5.59points vs107.64±4.07points)thanBO group. These comparative results were statistical significances(P<0.05).The patients of OIN group liked their own physicalappearance(95.4%vs28.6%),interested in sex(59.0%vs28.6%),functionof erection and maintenance(72.7%vs14.2%) were obviously better thanBO group,these differences were statistically significant (P<0.05).Conclusion:We failed to find enough evidence which modified radicalcystectomy orthotopic ileal neobladder procedure is better than radicalcystectomy Bricker operation in outcomes,such as the amount of bleedingduring operation,operation time,the hospital stays.However, the formercan be obtained the same effect with the latter, and the former canobviously improve the health related quality of life aftersurgery.Preserved sexual neurovascular bundle in modified radicalcystectomy orthotopic ileal neobladder,which can effectively restoresexual function and improve the quality of life.This operation is worthy ofgeneralization in clinical practice. |
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