中文摘要：

目的 比较腹腔镜和开放性原位回肠新膀胱术治疗膀胱癌的疗效,探讨两种术式的临床应用价值.方法 行原位回肠新膀胱术的膀胱癌患者82例,根据手术方法分为腹腔镜手术组（35例）和开放性手术组（47例）,比较两组患者手术用时、术中出血量、术后肛门恢复排气、排便时间和术后并发症发生情况,同时行新膀胱尿流动力学检查.结果 两组患者手术用时、盆腔淋巴结清扫阳性率比较均无统计学差异（均P ＞0.05）;腹腔镜手术组术中出血量和术后肛门恢复排气、排便时间均少于开放性手术组（均P＜0.05）.腹腔镜手术组日间尿控率、夜间尿控率、最大尿流率均高于开放性手术组（均P＜0.05）;新膀胱容量、新膀胱内压、剩余尿量比较,差异均无统计学意义（均P ＞0.05）;术后并发症发生率腹腔镜手术组低于开放性手术组（P＜0.05）.结论 相比开放性手术,腹腔镜原位回肠新膀胱术具有术中出血少、恢复快、疗效好、并发症较少等优势,但其手术用时长于开放性手术,且在肿瘤根治和新膀胱功能等方面与开放性手术效果相近.

英文摘要：

Objective To compare the therapeutic effect and postoperative complications of laparoscopic vs open cystectomy and urinary reconstruction with an orthotopic ileal neobladder in patients with bladder cancer. Methods Eighty two patients with bladder cancer underwent radical cystectomy and urinary reconstruction with an orthotopic ileal neobladder; 35 cases received laparoscopic operation （group 1） and 47 cases received open surgery. Operation time, blood loss, postoperative recovery, urodynamics and postoperative complications were compared between two groups. Results There were no signifi- cant differences in operation time and pelvic lymphadenectomy positive rate between two groups （all P 〉0.05）. Intraoperative bleeding and recovery time of bowel function after surgery in group 1 were less than those of group 2 （all P〈0.05）. daytime urinary control, nocturnal urinary control were better and maximum flow rate was higher in group 1 than those in group 2 （all P〈 0.05）; there were no significant differences in new bladder capacity, internal pressure and residual urine volume between two groups （all P 〉0.05）. Postoperative complication rate in group 1was lower than that in group 2（P〈0.05）. Conclusion In con- trast to open surgery, taparoscopic cystectomy with urinary reconstruction of orthotopic ileal neobladder shows better efficacy and less complications for patients with bladder cancer.