根治性膀胱全切手术及尿流改道方式对高龄患者围手术期并发症的影响

发布时间：2018-06-19 01:34

本文选题：膀胱切除术 + 尿道改流术　；参考：《北京大学学报(医学版)》2016年04期

【摘要】：目的:分析根治性膀胱全切的不同手术方式对高龄患者围手术期并发症的影响。方法:回顾北京大学第一医院泌尿外科2003年1月至2015年1月期间接受根治性膀胱全切手术的患者共1 432例,年龄大于75岁的高龄患者239例(中位年龄78岁),其中74例患者(31.0%)出现了围手术期并发症。根据手术方式的不同患者可分为回肠膀胱组和输尿管皮肤造口组,回肠膀胱组包括经腹腹腔镜和经腹开放膀胱全切回肠膀胱术两种术式,输尿管皮肤造口组包括经腹开放、经腹膜外开放、经腹腹腔镜膀胱全切输尿管皮肤造口3种术式,比较不同术式对高龄患者围手术期并发症的影响。结果:单因素分析结果显示,高龄患者出现围手术期并发症的相关因素包括年龄(P=0.012)、美国麻醉师协会(American Society of Anesthesiologists,ASA)评分(P=0.001)、淋巴结分期(P=0.043)和手术方式。有围手术期并发症发生的患者住院时间明显延长(中位住院时间34 d vs.21 d,P=0.002)。不同手术方式中,回肠膀胱组的围手术期并发症发生率高于输尿管皮肤造口术组(P=0.013),但经腹腹腔镜和经腹开放膀胱全切回肠膀胱术两种术式的围手术期并发症发生率差异无统计学意义(P=0.836);经腹开放、经腹膜外开放、经腹腹腔镜膀胱全切输尿管皮肤造口3种术式之间并发症的发生率差异有统计学意义(P=0.022)。多因素回归分析显示,年龄大于85岁(OR=4.856,95%CI:1.465~16.103,P=0.010)、ASA评分(P=0.008)和不同手术方式(P=0.016)与高龄患者围手术期并发症的发生存在相关性。结论:高龄患者接受根治性膀胱全切手术的围手术期并发症发生与患者年龄、术前ASA评分和手术方式存在相关性,经腹膜外开放膀胱全切输尿管皮肤造口术的围手术期并发症发生率低,对于高龄患者是一种合适的手术方案。
[Abstract]:Objective: to analyze the effects of radical cystectomy on perioperative complications of elderly patients. Methods: a total of 1432 patients undergoing radical cystectomy in the Department of Urology of No.1 Hospital of Peking University from January 2003 to January 2015 were reviewed, and 239 elderly patients older than 75 years old (median age 78 years old) were reviewed. 74 patients (31%) had perioperative complications. Patients with different surgical methods could be divided into the ileum bladder group and the ureterostomy group. The ileum and bladder group included two kinds of surgical procedures: abdominal laparoscopy and open bladder total resection of the cystectomy. The ureterostomy group was open through the abdomen, through the peritoneum, through the abdominal cavity. 3 methods of endoscopic bladder total ureteral orostomy were used to compare the effects of different surgical procedures on perioperative complications. Results: the results of single factor analysis showed that the factors associated with perioperative complications included age (P=0.012), American anesthesiologist Association (American Society of Anesthesiologists, ASA) score (P=0.00 1) lymph node staging (P=0.043) and surgical procedures. Patients with perioperative complications were significantly longer hospitalized (34 D vs.21 D, P=0.002). In different surgical methods, the peri operative complication rate in the ileum group was higher than that of the ureterostomy group (P=0.013), but abdominal laparoscopy and abdominal opening to the bladder There was no significant difference in the incidence of perioperative complications between the two methods of total resection of the ileum (P=0.836). The incidence of complications was statistically significant (P =0.022) between the open abdominal open, peritoneoscopic open ureterostomy (P =0.022). Multiple factor regression analysis showed that the age was greater than 85 years (OR =4.856,95%CI:1.465~16.103, P=0.010), ASA score (P=0.008) and different surgical methods (P=0.016) and the incidence of perioperative complications in elderly patients. Conclusion: the perioperative complications of elderly patients undergoing radical cystectomy are related to the age of the patients, the preoperative ASA score and the surgical methods are related to the peritoneum. The incidence of perioperative complications of external open radical cystectomy and ureterostomy is low, which is a suitable surgical procedure for elderly patients.
【作者单位】：北京大学第一医院泌尿外科北京大学泌尿外科研究所国家泌尿男性生殖系肿瘤研究中心;
【分类号】：R737.14

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