Efficacy Evaluation Of Different Radical Cystectomy In Elderly Patients With Bladder Cancer

Objective:To provide theoretical basis for the choice of surgical methods in elderly patients with bladder cancer According to comparison of intraoperative and postoperative conditions in different surgical procedures and urinary diversion for patients accepted radical cystectomy and the risk factors of short-term and long-term complications after radical cystectomy.Methods:A retrospective analysis of clinical data of 46 elderly patients with bladder cancer treated by radical cystectomy from January 2012 to December 2018.According to different urinary diversion methods and different surgical methods,the patients were divided into ileal conduit group and cutaneous ureterostomy group,laparoscopic group and open group.By compared the operation time,intestinal recovery time,and whether recent and long-term complications,bleeding volume,blood transfusion volume,average postoperative hospital stay,drug ratio,pathological staging,etc.,to analysis the difference of urinary diversion methods and different surgical methods According to the different ways of urinary diversion,the patients were divided into two groups.The influencing factors,such as age,BMI,previous surgical history,pathological stage,operation time,bleeding volume,intestinal recovery time,blood transfusion volume,surgical methods,and ASA score.were analyzed by univariate and multivariate statistics to explore the risk factors of short-term and long-term complications after different urinary diversion operations.Results:1.In the comparison between laparoscopic surgery and open surgery.Patients in the ileal channel group who underwent laparoscopic surgery were better than the open group in terms of postoperative hospital stay,intestinal recovery time,and drug ratio,the difference was statistically significant(P<0.05).The difference of operation time,bleeding volume,blood transfusion volume,whether recent and long-term compli-cations,pathological staging was not statistically significant(P>0.05).Patients in the cutaneous ureterostomy group who underwent laparoscopic surgery were better than the open group in terms of postoperative hospital stay,intestinal recovery time,and drug ratio,the difference was statistically significant(P<0.05).The difference of opera-tion time,bleeding volume,whether recent and long-term complications,pathological staging was not statistically significant(P<0.05).However,incutaneous ureterostomy group,the transfusion volume in the laparoscopic group was higher than the open group,and the difference was statistically significant(P<0.05).2.Comparative analysis of different urinary diversion methods:In laparoscopic group,the incidence of long-term complication in the ileal channel group was significantly lower than cutaneous ureterostomy group,and the difference was statistically significant(P<0.05);The operation time and intestinal recovery time were significantly longer than cutaneous ureterostomy group,and the difference was statistically significant(P<0.05).The difference of bleeding volume,blood transfusion volume,postoperative hospital stay,whether recent and long-term complications,drug ratio,pathological staging,was not statistically significant(P>0.05).In open group,the operation time,blood transfusion volume in the ileal channel group was significantly higher than cutaneous ureterostomy group,the difference was statistically significant(P<0.05);the pathological staging in the ileal channel group was significantly lower than cutaneous ureterostomy group,and the difference was statistically significant(P<0.05);The difference of bleeding volume,average postoperative hospital stay,intestinal recovery time,whether recent and long-term complications,drug ratio was not statistically significant3.Pathological staging is an independent risk factor for the short-term and long-term complicat-ions of the ileal channel group.4.Previous surgical history is an independent risk factor for the short-term and long-term complications of the cutaneous ureterostomy group.Conclusion:1.Laparoscopic radical cystectomy and ileal conduit are also safe and feasible for elderly patients without abdominal operation history and low pathological stage..2.In different radical cystectomy,the difficulty of surgery and intestinal conditions can affect the choice of urinary diversion.The ileal access is preferred for the patients with good condition and long life expectancy to improve the long-term quality of life after surgery.