摘要目的：比较机器人辅助腹腔镜下膀胱癌根治性切除术后回肠膀胱术和原位新膀胱术围手术期治疗效果。方法：回顾性分析了2015年1月到2021年12月于空军军医大学第一附属医院泌尿外科行机器人辅助腹腔镜下膀胱癌根治性切除术后回肠膀胱术和原位新膀胱术患者的人口学和临床病理资料,共纳入50例回肠膀胱术患者和21例原位新膀胱术患者。根据年龄、性别、年龄调整的Charlson共病指数(aCCI)、新辅助化疗史、外科手术史进行1:1倾向性评分匹配（PSM）,比较两组的围手术期资料和并发症。结果：PSM前原位新膀胱术组相比回肠膀胱术组年龄较小[（54.05±4.75） vs. （58.82±9.95） 岁]、aCCI值低[（3.29±0.85） vs. （3.90±1.09）]、住院时间短[10（11,12） vs. 12（11,14） d]、淋巴结阳性率低[9.5%（2/21） vs. 20%（10/50）],差异具有统计学意义（P<0.05）。PSM前后原位新膀胱术组相比回肠膀胱术组手术时间长[540（490,580） min vs. 375（330,400） min;520（490,580） min vs. 375（310,400） min],差异有统计学意义（P<0.05）。发热和肾积水分别是原位新膀胱术组30 d内和90 d后的显著并发症,PSM后发热仍然是原位新膀胱术组30 d内的显著并发症,差异有统计学意义（P <0.05）。结论：机器人辅助腹腔镜膀胱癌根治性切除术后原位新膀胱术安全可行,且与回肠膀胱术相比,术后早期和中晚期并发症并不显著增加。
Abstract：Objective： To compare the perioperative outcomes of robotic-assisted laparoscopic radical resection of bladder cancer with ileal bladder and orthotopic neobladder. Methods： The demographics of patients undergoing robotic-assisted laparoscopic radical resection of bladder cancer after ileal bladder surgery or orthotopic neobladder surgery in the Department of Urology, The First Affiliated Hospital of Air Force Military Medical University from January 2015 to December 2021 were retrospectively analyzed. The clinicopathological data of 50 patients with ileal bladder surgery and 21 patients with orthotopic neobladder were included. The 1：1 propensity score matching （PSM） was performed according to age, sex, age-adjusted Charlson comorbidity index （aCCI）, history of neoadjuvant chemotherapy, and history of surgery, and perioperative data and complications were compared between the two groups. Results： The patients in the pre-PSM neobladder group was younger [（54.05±4.75） vs. （58.82±9.95） years], aCCI value was lower [（3.29±0.85） vs. （3.90±1.09）], hospital stay was shorter [10 （11, 12） vs. 12（11, 14） d] and lymph node positive rate was lower [9.5% （2/21） vs. 20% （10/50）] than those in the ileal bladder group with the difference being statistically significant （P<0.05）. The operative time in the orthotopic neobladder group before and after PSM was longer than that in the ileal bladder group [540 （490, 580） min vs. 375 （330, 400） min; 520 （490±580） min vs. 375 （310,400） min] with the difference being statistically significant （P<0.05）. Fever and hydronephrosis were the main complications within 30 days and after 90 days in the orthotopic neobladder group, respectively. Fever after PSM was still a main complication within 30 days in the orthotopic neobladder group, and the difference was statistically significant （P<0.05）. Conclusion： Orthotopic neobladder after robot-assisted laparoscopic radical resection of bladder cancer is safe and feasible, and compared with ileal bladder , there is no significant increase in early and middle-late postoperative complications.
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