膀胱根治术后砖状尿改道:腹腔镜与机器人方法在生活质量、围手术期结局和术后并发症方面的比较分析

IF 0.8 Q4 SURGERY
Chirurgia Pub Date : 2025-08-01 DOI:10.21614/chirurgia.3156
Cosmin-George Radu, George Daniel Rădăvoi, Justin Aurelian, Ion-Florin Achim, Iulia Andras, Maximilian Buzoianu, Elisabeta Ioana Hiriscau, Nicolae Crisan, Florin Grama, Silviu Constantinoiu, Viorel Jinga
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引用次数: 0

摘要

导念:根治性膀胱切除术联合回肠导管导尿转移(Bricker技术)仍然是局部肌性浸润性膀胱癌(MIBC)和高风险非肌性浸润性膀胱癌(NMIBC)的标准治疗方法。在向微创技术过渡的过程中,比较腹腔镜根治性膀胱切除术(LRC)和机器人辅助根治性膀胱切除术(RARC)变得至关重要,特别是在围手术期发病率和术后健康相关生活质量方面。然而,来自东欧的真实数据仍然有限。目的:比较经腹腔镜和机器人入路行膀胱根治术合并Bricker尿转移患者的围术期和术后临床结果和生活质量。材料和方法:这是一项回顾性观察性研究,于2023年3月至2025年3月在罗马尼亚克卢日-纳波卡的两个学术中心进行。共纳入37例诊断为MIBC的患者,并根据手术入路分为两组:腹腔镜(n=22)和机器人(n=15)。术前和术后收集临床、生物学和手术参数。3个月时采用EQ-5D-5L和EQ-VAS评估患者的生活质量。统计学分析采用t检验、Mann-Whitney U检验、线性回归模型和相关系数,显著性阈值为p 0.05。结果:机器人组术后肾功能明显改善(eGFR: 84.2 +- 5.88 vs 66.55 +- 5.59 ml/min/1.73m²;p=0.041),中位住院时间缩短(7天,IQR 6â?8 vs. 9天,IQR 7â? 13;P =0.045),尽管手术时间更长(463 +- 25.4分钟vs 415 +- 21.52分钟)。腹腔镜组术后严重并发症发生率明显高于腹腔镜组(54.5% vs. 6.7%; p=0.004)。先前存在的尿路感染在LRC组中更为常见(45.5%比20%),与术后肾功能下降独立相关(ò= -0.39,p=0.005)。尽管EQ-5D-5L效用指数较低(0.52 +- 0.12 vs. 0.72 +- 0.05; p=0.02),但机器人组的EQ-VAS平均评分较高(84.93 +- 2.64 vs. 76.81 +- 4.42; p 0.01),表明尽管客观上功能预后降低,但总体健康感知良好。术后并发症与EQ-VAS评分降低显著相关(71.39 +- 20.49比88.37 +- 71.13;p=0.004)。结论:在东欧现实世界的临床环境中,机器人入路根治性膀胱切除术合并Bricker尿转移与更好地保存肾功能、更短的住院时间和更低的严重并发症发生率相关。术前尿路感染对肾功能的负面影响与基线eGFR无关。虽然RARC患者在EQ-5D-5L测量中表现出更明显的功能障碍,但他们的整体健康感知(EQ-VAS)明显更好,这表明技术期望和术后满意度的影响。这些结果支持机器人手术在先进泌尿外科中心的实施,并强调需要前瞻性、随机试验,延长随访时间,关注功能结果和生活质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Bricker Urinary Diversion after Radical Cystectomy: A Comparative Analysis of Laparoscopic vs. Robotic Approach in Terms of Quality of Life, Perioperative Outcomes and Postoperative Complications.

Introduction: Radical cystectomy with ileal conduit urinary diversion (Bricker technique) remains the standard treatment for localized muscle-invasive bladder cancer (MIBC), as well as for high-risk non-muscle-invasive bladder cancer (NMIBC). Amid the transition toward minimally invasive techniques, comparing laparoscopic radical cystectomy (LRC) with robot-assisted radical cystectomy (RARC) becomes essential, particularly regarding perioperative morbidity and postoperative health-related quality of life. However, real-world data from Eastern Europe remain limited. Objective: To compare peri- and postoperative clinical outcomes and quality of life in patients undergoing radical cystectomy with Bricker urinary diversion via laparoscopic versus robotic approach. Materials and Methods: This is a retrospective, observational study conducted between March 2023 and March 2025 in two academic centers in Cluj-Napoca, Romania. A total of 37 patients diagnosed with MIBC were included and allocated into two groups based on the surgical approach: laparoscopic (n=22) and robotic (n=15). Clinical, biological, and surgical parameters were collected pre- and postoperatively. Quality of life was assessed at 3 months using the EQ-5D-5L and EQ-VAS instruments. Statistical analyses included t-tests, Mann-Whitney U tests, linear regression models, and correlation coefficients, with a significance threshold of p 0.05. Results: The robotic group demonstrated significantly better postoperative renal function (eGFR: 84.2 +- 5.88 vs. 66.55 +- 5.59 ml/min/1.73m²; p=0.041) and a shorter median hospital stay (7 days, IQR 6â?"8 vs. 9 days, IQR 7â?"13; p=0.045), despite a longer operative time (463 +- 25.4 vs. 415 +- 21.52 minutes). Severe postoperative complications were significantly more frequent in the laparoscopic group (54.5% vs. 6.7%; p=0.004). Preexisting urinary tract infections, more common in the LRC group (45.5% vs. 20%), were independently associated with decreased postoperative renal function (ò = -0.39, p=0.005). The mean EQ-VAS score was higher in the robotic group (84.93 +- 2.64 vs. 76.81 +- 4.42; p 0.01), despite a lower EQ-5D-5L utility index (0.52 +- 0.12 vs. 0.72 +- 0.05; p=0.02), indicating an overall favorable health perception despite objectively reduced functional outcomes. Postoperative complications were significantly correlated with decreased EQ-VAS scores (71.39 +- 20.49 vs. 88.37 +- 71.13; p=0.004). Conclusions: In the real-world clinical setting of Eastern Europe, the robotic approach to radical cystectomy with Bricker urinary diversion was associated with better preserved renal function, shorter hospitalization and a lower incidence of severe complications. Preoperative urinary tract infections negatively impacted renal function independently of baseline eGFR. Although RARC patients showed more pronounced functional impairments as measured by EQ-5D-5L, their overall health perception (EQ-VAS) was significantly better, suggesting the influence of technological expectations and postoperative satisfaction. These results support the implementation of robotic surgery in advanced urological centers and highlight the need for prospective, randomized trials with extended follow-up focusing on functional outcomes and quality of life.

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来源期刊
Chirurgia
Chirurgia Medicine-Surgery
CiteScore
1.00
自引率
0.00%
发文量
75
审稿时长
4-8 weeks
期刊介绍: Chirurgia is a bimonthly journal. In Chirurgia, original papers in the area of general surgery which neither appeared, nor were sent for publication in other periodicals, can be published. You can send original articles, new surgical techniques, or comprehensive general reports on surgical topics, clinical case presentations and, depending on publication space, - reviews of some articles of general interest to surgeons from other publications. Chirurgia is also a place for sharing information about the activity of various branches of the Romanian Society of Surgery, information on Congresses and Symposiums organized by the Romanian Society of Surgery and participation notes in other scientific meetings. Letters to the editor: Letters commenting on papers published in Chirurgia are welcomed. They should contain substantive ideas and commentaries supported by appropriate data, and should not exceed 2 pages. Please submit these letters to the editor through our online system.
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