全膀胱切除尿路重建术后早期并发症及危险因素探讨

发布时间：2018-05-17 15:31

本文选题：膀胱癌 + 全膀胱切除术　；参考：《大连医科大学》2014年硕士论文

【摘要】：研究背景及目的研究全膀胱切除尿路重建术后早期并发症及其相关风险因素，并据此为医护人员对患者进行术后并发症相关危险因素的管控提供参考。膀胱癌是泌尿生殖系统最常见的恶性肿瘤之一，2008年全国膀胱癌发病率为7.49/10万，并呈逐年上升趋势。据全国肿瘤防治研究办公室最新发布的数据流行病学资料显示，大连地区是我国膀胱癌的高发地区，其膀胱癌发病率为11.85/10万，居全国之首。全膀胱切除尿路重建术是治疗肌层浸润性膀胱肿瘤以及复发性膀胱肿瘤的标准方法，通过治疗可以使患者的10年生存率明显提高。然而该手术是泌尿外科最为复杂的手术之一，加之患者普遍年龄较高，合并诸多基础疾病等因素导致术后时常出现并发症，不利于患者顺利康复。国外不少研究结果显示针对导致术后产生并发症的危险因素进行积极管控可以显著减少相应并发症的出现。然而，目前国内相关领域的研究资料还相对欠缺，不利于手术的广泛开展和术后并发症的控制。本研究采用“手风琴式”术后并发症分级系统对大连医科大学附属第二医院泌尿外科2001年以来因膀胱癌行膀胱全切尿流改道术的67位患者术后早期并发症进行回顾性分析，并针对所出现的并发症进行相关风险因素的探究，以期为今后预防及减少同类手术相关并发症提供参考。方法本课题采集了大连医科大学附属第二医院泌尿外科2001年以来因膀胱癌行膀胱全切尿流改道术的67位患者的临床资料进行回顾性分析，以“手风琴式”术后并发症分级系统对术后早期出现的并发症进行分级，再按照有关文献报道的分类依据对所出现的并发症进行归类统计。之后所有病例分为并发症组和无并发症组进行组间单因素分析，筛选出的相关危险因素经整合后进行多因素logistic回归分析。结果在67例患者中出现并发症者42例，占62.7%，其中出现轻度并发症24例，占并发症组患者的57.1%；中度并发症10例，占21.4%；重度并发症8例，占19.1%。同时出现两项及以上并发症的患者为19例，占患者总数的23.4%。胃肠道相关并发症的发生率最高，其次是低血容量及电解质失衡相关并发症，感染性并发症亦不少见，其余并发症分类项发生率相对较低。单因素组间分析结果显示导致术后并发症的风险因素包括：年龄、吸烟史、白蛋白、谷草转氨酶、谷丙转氨酶、血压、血糖、ASA等级、肿瘤分期、手术时间、术中失血量和术中输血量。对上述危险因素整合后经多因素logistic回归显示：糖尿病、术前肝功能异常和术中出血量是引起术后并发症的重要风险因素。结论 1.膀胱全切尿流改道术后并发症发生率较高，但重度并发症及围术期死亡率均较低，，因此本研究认为该手术仍是我国治疗肌层浸润性膀胱肿瘤安全且有效的治疗方式。 2.胃肠道并发症、低血容量电解质失衡相关并发症、感染是术后早期最常见的并发症。 3.糖尿病、术前肝功能异常和术中出血量是引起术后并发症的重要风险因素。其次，高血压、手术时间、手术方式、吸烟史亦是导致术后并发症的相关危险因素。 4.年龄和肿瘤分期不能作为术后早期并发症的独立危险因素，其与术后早期并发症的关系尚不明确。
[Abstract]:Background and purpose of research
To study the early complications and related risk factors of urinary tract reconstruction after total cystectomy, and to provide a reference for the medical and nursing staff to control the risk factors of postoperative complications.
Bladder cancer is one of the most common malignant tumors in the genitourinary system. The incidence of bladder cancer in China is 7.49/10 million in 2008 and is increasing year by year. According to the latest data epidemiological data published by the National Cancer Prevention and Control Research Office, the Dalian area is a high incidence area of bladder cancer in China, and the incidence of bladder cancer is 11.85/10 million. Total cystectomy is the standard method for the treatment of invasive bladder tumor and recurrent bladder tumor, which can improve the 10 year survival rate of the patients. However, this operation is one of the most complicated operations in the Department of urology. It is not conducive to the smooth recovery of the patients after the operation. Many foreign research results show that the active control of the risk factors causing complications after the operation can significantly reduce the occurrence of the corresponding complications. However, the research data in the domestic related fields are relatively deficient at present, which is not conducive to the extensive development of the operation and the development of the operation. Control of postoperative complications. This study reviewed the early complications of 67 patients in the Department of Urology of the Second Affiliated Hospital of Dalian Medical University since 2001 in the Department of Urology of the second hospital, affiliated with bladder cancer. In order to provide reference for future prevention and reduction of similar surgical complications.
Method
In this study, the clinical data of 67 patients in the Department of Urology of the Second Affiliated Hospital of Dalian Medical University since 2001 were reviewed and analyzed. The complications of the postoperative complications after the "accordion" complication classification system were classified according to the related literature. According to the classification of the complications, all the cases were divided into single factor analysis in the complication group and the non complication group, and the related risk factors were integrated and analyzed by multiple factor Logistic regression after integration.
Result
Among the 67 patients, there were 42 cases of complications, accounting for 62.7%, of which 24 cases had mild complications, 57.1% of the complications, 10 cases of moderate complications, 21.4%, and 8 cases of severe complications, and 19 patients with 19.1%., which had two and more complications, and the incidence of 23.4%. gastrointestinal complications was the highest. Followed by low blood volume and electrolyte imbalance related complications, infectious complications are not rare, the incidence of other complications classification is relatively low.
The risk factors of postoperative complications included age, smoking history, albumin, glutamic aminotransferase, alanine aminotransferase, blood pressure, blood sugar, ASA grade, tumor staging, operation time, intraoperative blood loss and intraoperative blood transfusion. The risk factors were integrated by multiple factor Logistic regression after integration of the risk factors: diabetes, surgery Abnormal liver function and intraoperative blood loss are important risk factors for postoperative complications.
conclusion
1. the incidence of complications after total bladder resection is high, but severe complications and perioperative mortality are low. Therefore, this study is still a safe and effective treatment for invasive bladder tumor in our country.
2. gastrointestinal complications, low volume electrolyte imbalance related complications, infection is the most common early postoperative complications.
3. diabetes, abnormal preoperative liver function and intraoperative bleeding are important risk factors for postoperative complications. Secondly, hypertension, operation time, mode of operation, and smoking history are also related risk factors for postoperative complications.
4. age and tumor staging are not independent risk factors for early postoperative complications, and their relationship with early postoperative complications is unclear.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.14

【参考文献】