Short-Term Efficacy After Laparoscopic Radical Cystectomy:Comparison Of Ileal Conduit To Orthotopic Ileal Neobladder

Objective:Summary laparoscopic cystectomy ileal conduit neobladder (Bricker ileal neobladder) and orthotopic ileal neobladder (Hautmann orthotopic neobladder) experience in the Surgery and compare the short-term efficacy of the two types of urinary diversion for invasive bladder cancer.Methods: Retorspectly analyze the patients in our hospital who accepted Laparoscopic radical cystectomy from 2010.10 to 2014.4,74 of them accepted ileal conduit neobladder,30 of them accepted continent orthotopic neobladder. Analyze the general clinical data、postoperative recovery、postoperative complications and Oncology feature in the two groups.Results:2 patients converted to open surgery because of Serious sticky and Heavy bleeding in group A,No demonstrable difference were found in operation time (262.7±66.4、314.8±84.6 min) (P=0.368)、blood loss (456.7±261.3、432±308.4ml) (P=0.137)、intraoperative blood transfusion rate 22.2%(16 cases)、33.3%(10 cases) (P=0.356)、The number of intraoperative lymph node dissectionl5.4±2.6、14.9±2.9 (P=0.39)、postoperative hospital stay (12.7 ± 5.4,15.1±6.1 d) (P= 0.061)、pecimens positive margin rate and postoperative pathology results between the two groups.8 cases of positive lymph nodes were revealed by pathological examination,7 cases in Bricker conduit group,6 cases of them were Nl,1 case was N2, tumor recurrence or metastasis occurred in 3 of them during follow-up.1 cases in Hautmann neobladder group was Nl, and it result in tumor recurrence or metastasis。 There are significant difference in Postoperative intestinal function recovery time (4.2±1.4、5.3±2.2d) (P=0.002)and The complication rate 31.9%(23 cases)> 53.3%(16 cases) (.P=0.043), After 6 months, the daytime and nighttime urinary control were 76.9%(20/26),57.7%(15/26), after 12 months, the daytime and nighttime urinary control Increased to 90.9%(20/22),81.8 (18/22)%. Tumor infiltrate the bladder neck or the trigonee in 18 cases in Bricker conduit group, tumor recurrence or metastasis occurred in 9 cases,6 of their tumor infiltrate the bladder neck or the trigonee. Two cases developed tumor recurrence or metastasis in during follow-up Hautmann neobladder group and both of their tumor infiltrate the bladder neck or the trigonee before surgery。Conclusion:The incidence of postoperative complications of the Bricker ileal neobladder group was significantly lower than the Hautmann orthotopic neobladder group.The probability of tumor recurrence or metastasis is higher when tumor invading triangle area or bladder neck and combineing positive lymph node. For older or poor surgical tolerance patients, the surgical approach of Bricker ileal neobladder can be first considered.For those who are generally good、desiring a high quality of life, Hautmann orthotopic neobladder is an ideal approach。...