内脏脂肪厚度对不同方式膀胱全切回肠膀胱术手术时长及术后并发症的影响

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ABSTRACT：ObjectiveTo explore the effects of visceral fat thickness on the operation time，intraoperative bleeding， postoperativerecoveryandcomplicationsofoensurgery，laparoscopic surgeryandrobot-asistedlaparosopic totalcystectomy withilealconduit（Brickersurgery）.MethodsThe clinicaldataof 373patients with blader malignancyundergoing Bricker surgery nour hospitalduringJan.2O15andJul.2O25 wereretrospectivelyanalyzed.Thepatients were divided intothree groups based on the surgical approaches： open surgery group （ n=120 ），laparoscopic surgery group （ n=139 ），and robot-assisted laparoscopic surgery group （RLS group， n=114⋅ . The patients were further divided into group A（with visceral fat thickness <5.06cm ）and group B（with visceral fat thickness ⩾5.06cm ）based on preoperation CT results.The parameters were statisticallyanalyzedandcolected，includingage，gender，underlyingiseases，operationtime，intraoperativebloodloss，blod transfusion，postoperative exhaustion time，hospital stayand postoperative complications.ResultsIn patients undergoing open surgery and Bricker surgery，the operative time for group B was （ 264.00±68.11 ）min and（ （310.06±42.81 ）min， respectively，longer than that of group A. The intraoperative blood loss was （482.46±192.84） mLand （392.54±147.00 ） mL，respectively，also more than that of group A（ P<0.05） .The incidence of severe complications such as postoperative wound infection，urinary fistula，and bleeding in group B was 22.8% and 16.4% ，respectively，significantly higher than that of group A （ P<0.05 ）. In the open surgery group，although the postoperative recovery time of gastrointestinal function of group B was similar to that of group A，the average postoperative hospital stay was （22.91±13.09） d，which was significantly longer than that of group A[（18.95±4.42）d，P<0.05] . For group B，RLS could significantly reduce the intraoperative blood losscompared toopensurgeryandtraditionallaparoscopic surgery，lowertheincidenceof severecomplications，and shorten the hospital tay.ConclusionFor patients with bladdercancer who are scheduled for Bricker surgery，if preoperative CT reveals thick visceralfat，RLSshould beconsidered.Thisapproachcaneffectivelyreducethesurgical dificultyandincidence of severe postoperative complications，and accelerate the postoperative recovery.

KEY WORDS： Bricker surgery； blader cancer; visceral fat; postoperativecomplication；open surgery; laparoscopic surgery; robot-asssted laparoscopic surgery; operation time

摘要：目的探究内脏脂肪厚度对开放手术、腹腔镜手术和机器人辅助下腹腔镜膀胱全切回肠膀胱术（Bricker）的手术时长、术中出血情况、术后恢复时长和并发症发生情况的影响。（剩余10773字）