Comparison Of The Efficacy Of Laparoscopic Radical Cystectomy With Different Urinary Diversion

Objective The bladder cancer is the most common malignancy in urinary system.With exposure to carcinogenic factors,the incidence has been increasing year by year.Smoking not only increases the incidence of bladder cancer but also makes the bladder cancer occuring earlier.Radical cystectomy and lymphadenectomy are the gold standard for the treatment of musle invasive bladder cancer and high-risk superficial bladder cancer.The first successful resection of bladder cancer was in nineteenth Century.With the development of medical and technology,the surgery of bladder cancer was changed from traditional surgery to laparoscopic surgery which has the advantage of quicker recovery.Urethral reconstruction is very important after the surgery of the bladder cancer.We intend to compare the time of the surgery,quality of life,the early and late complications among the three urinary diversion.Subjects and methods A study included 63 patients with invasive bladder cancer who underwent laparoscopic radical cystectomy.There were 45 males and 18 females with the average of 59-67 years.There were 28 patients who underwent orthotopic neobladder.There were 16 patients who underwent Bricker because of urethral problem,There were 19 patients who underwent the UUCS because of intestinal diseases and the body cannot tolerate other surgery.we used the t test to compare operation time and use F test to compare the quality of life.We use chi–square test to test the early and late complications.If P<0.05,there was statistical difference in the early and late complications.Results There was statistical difference in surgery time of the three groups.The orthotopic neobladder group and Bricker group were longer than the UUCS group.Life quality in physiological aspect are respectively 67.3±1.7,65.8±1.6,41.8±3.6.Life quality in psychological aspect are respectively 70.4±1.7,62.7±1.6,25.4±1.7.Life quality in social relationship aspect are respectively 52.5±3.2,52.5±3.4,33.5±4.0.Life quality in enviromental aspect are respectively61.5±2.5,61.2±2.0,34.4±2.7.Patients treated with the UUCS differ significantly with other operation methods in all aspects of life quality(P<0.001).The other kinds of operation methods are no significant difference in physiological aspect,social relationship aspect,enviromental aspect(P>0.05),but are significant difference in psychological aspect(P<0.05).There was no statistical difference in early complications(P=0.347)of the three groups,there was statistical difference in late complications of the three groups(P<0.001).Compare the orthotopic neobladder group and Bricker group: P=0.035.Compare the orthotopic neobladder group and the UUCS group :P<0.001.Compare Bricker group and the UUCS group: P=0.031.Conclusion The orthotopic neobladder should be chosen first among the three groups due to the superiorities that approximate physiological urination maximatily,raise life quality.