Long-term Efficacy And Quality Of Life Assessment Of Patient Underwent Laparoscopic Radical Cystectomy And Ileal Orthotopic Neobladder

Objective:The clinical efficacy and quality of life of the patients underwent radical cystectomy and ileal orthotopic neobladder were evaluated by systematic follow-up for more than one year.Method:The patients who underwent laparoscopic radical cystectomy and ileal orthotopic urinary diversion from November 2008 to January 2018 were followed up.Through the examination of serum creatinine and blood urea nitrogen,electrolyte,urinary tract imaging,urodynamic study,cystoscopy and other examinations,relevant quality of life assessment were compared before and after surgery,systematic evaluation of urine control and neobladder function,renal function,metabolic status and related complications and quality of life were evaluated.SPSS 21.0 was used to process the data and to do statistical analyze.Result:A total of 72 patients or family members were contacted via telephone,of which 12 died,13 could not be followed up due to various reasons,and 47 were willing to be followed up.The follow-up period ranged from 14 to 110 months,with an average of 44.2 months.Of the 47 patients followed up,38 were males and 9 were females.The age ranged from 35 to 80 years,with an average age of 64.29± 8.74 years.Among the 47 patients,serum Cr 52-229 mmol/L,average 89(±18 mmol/L),BUN 4-14 mmol/L,average 6(±2.7 mmol/L).Blood K 3.3-4.8 mmol/L,average 4±0.38 mmol/L,blood Na 131-144.2,average 139.14±3.63 mmol/L,blood Ca 1.88-2.47,average 2.23±0.12 mmol/L,blood Cl 93.8-117.9,average 103.78±4.29 mmol/lL.The neobladder capacity was 185-602 mL,with an average of 409±90 ml;the filling pressure of the new bladder was 15-31.6 cmH20,with an average of 26.16±5.1 cmH20;the compliance of the new bladder was 14-40 ml/cmH20,with an average of 26.5±6.3 ml/cmH20;the maximum urinary flow rate was 7.1-20.3 ml/s,with an average of 12.8±3.0ml/s;and the maximum urinary flow rate was 26-42 cm H20 and 36.9±5.3cm H20.Of the 47 patients,3(6.4%)had complete urinary incontinence.The average times of urination was 4.36 in the daytime and 2.48 in the night.43 patients(91.4%)had controllable urination during the day and 35 patients(74.4%)had controllable urination at night.35 cases(74.4%)had controllable urination during daytime and night.The quality of life score of 47 patients after new bladder surgery was 104-132,with an average of 117.37(±7.049),indicating that the patients had a higher score in quality of life and a better quality of life.Conclusion:Laparoscopic ileal orthotopic urinary diversion can achieve better long-term renal function,protection and electrolyte balance.2.Precise operation,adequate neobladder capacity and postoperative pelvic floor muscle exercise can achieve better urinary control in most patients.3.postoperative in-situ urination which is close to the normal physiological bladder can maintain a better quality of life for patients4.Strict control of surgical indications can effectively reduce the recurrence of postoperative urethral tumors.