208例根治性膀胱切除术术后并发症的危险因素分析  

Risk factor analysis of post-operative complications in radical cystectomy for bladder transitional cell cancer: retrospective assessment from 208 consecutive cases

作　　者：温英武[1,2,3] 申克辉[1,2,4] 虞巍[1,2] 郭应禄[1,2] 何群[1,2] 席志军[1,2] 

机构地区：[1]北京大学第一医院泌尿外科 [2]北京大学泌尿外科研究所国家泌尿男性生殖系肿瘤中心,北京100034 [3]河北开滦(集团)有限公司医院,唐山063000 [4]河北省固安县医院,固安065500

出　　处：《北京大学学报（医学版）》2011年第4期565-569,共5页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金资助(30571853和30872588)~~

摘　　要：目的:了解根治性膀胱切除术后短期并发症的发生情况及相关的危险因素。方法:回顾性分析2006年1月1日至2009年7月31日北京大学第一医院泌尿外科行根治性膀胱切除的208例膀胱移行上皮细胞癌连续病例,男182例,女26例,平均年龄65岁,记录短期术后并发症(90 d内)的发生情况,并将并发症的发生情况与患者术前和术中的资料进行统计学分析。结果:208例中男性182例(87.5%),女性26例(12.5%),平均年龄65岁,出现并发症的病例数为160例(76.9%),同时出现2种以上并发症的病例数为46例(22.2%)。并发症出现频率较高的为失血(75例)、术后肾功能异常(31例)和肠梗阻(29例)。单因素分析显示与总并发症有统计学意义的危险因素有手术时间(P=0.048)、高血压(P=0.047)、术前肌酐水平(P=0.017);在多因素分析中手术时间、术前肌酐水平和术前高血压是发生并发症的危险因素。结论:根治性膀胱切除术后的短期并发症的发生率较高,与并发症的发生有统计学意义的因素有手术时间、高血压和术前肌酐水平,因此,严格选择病例,尽可能改善可控的术前状况以及提高手术团队的经验有助于减少病人术后的并发症。Objective： To describe early complications（within 90 days） after radical cystectomy and to analyze the associated specific risk factors.Methods： The clinical data from 208 consecutive cases of muscle invasive bladder cancer were collected and reviewed.Potential variables predictive of early morbidity were retrospectively analyzed.Results： Of the 208 subjects,160（76.9%）developed at least 1 postoperative complication and 46（22.2%） at least 2 complications.The most frequent complications presented were blood loss（75 cases）,postoperative renal insufficiency（31 cases）,and intestinal obstruction（29 cases）.In univariate analysis,operative time,hypertension and preoperative creatinine le-vel were associated with the development of complications.On multivariate analysis,operative time,preoperative creatinine level were the significant factors.Conclusion： Morbidity remains high after radical cystectomy.The operative time,preoperative creatinine level and hypertension may be associated with the postoperative complications.Acknowledgement of the patients＇ specific risk factors and monitoring perioperative processes may incrementally reduce risks and improve outcomes of the patients.

关 键 词：膀胱肿瘤 膀胱切除术 手术后并发症 危险因素 

分 类 号：R737.14[医药卫生—肿瘤]