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根治性膀胱切除术后患者的生活质量
研究背景:根治性膀胱切除术回肠代膀胱或原位膀胱替代是目前重建膀胱的两种常用的方式,各有利弊,关于哪种方式应该成为主导则常常成为人们争论的焦点.
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腹腔镜下根治性膀胱切除术中值得关注的几个问题
根治性膀胱切除术( radical cystectomy,RC)是目前公认的治疗肌层浸润性膀胱癌的金标准.自从1993年Sanchez等[1]报道首例腹腔镜下根治性膀胱切除(laparoscopic radical cystectomy,LRC)-回肠通道术以来,随着腹腔镜器械和技术的不断改进,LRC已逐渐被患者和医生接受.
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腹腔镜根治性膀胱切除及原位尿流改道
膀胱尿路上皮癌是常见的泌尿系肿瘤,根治性膀胱切除是肌层浸润性膀胱癌的标准治疗方法[1].经过二十多年的发展,开放根治性膀胱切除(open radical cystectomy, ORC)及原位尿流改道已成为主要的手术方式.随着技术和设备的不断完善,腹腔镜手术在泌尿外科的应用已得到了广泛的拓展,在腹腔镜下根治性膀胱切除(laparoscopic radical cystectomy, LRC)、原位尿流改道方面已取得了较大的进步.然而,由于手术的步骤较多、操作复杂、手术时间长,该手术是否能成为常规的手术方式一直存在着争议[2].
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Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months (range, 0.2-139.1 months). Thirty-day mortality was (1.4%). The 5-year recurrence-free survival, cancer-specific survival (CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1-T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease (81.4%vs. 34.9%, P<0.001). For the 38 patients (14%) with lymph node involvement, the 5-year CSS rate was 27.7%-significantly lower than that of patients without lymph node metastasis (P < 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor (98.1%vs. 68.1%, P<0.001). Multivariate Cox regression showed that patient age (hazard ratio, 2.045; P = 0.013) and T category (hazard ratio, 2.213; P < 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy.