根治性膀胱全切术后肠梗阻的危险因素分析(附740例报道)  

Risk factors for the development of postoperative paralytic ileus after radical cystectomy: a report of 740 cases

作　　者：孟一森[1,2] 苏杨[1,2] 范宇[1,2] 虞巍[1,2] 王宇[1,2] 郑卫[1,2] 谌诚[1,2] 周利群[1,2] 张骞[1,2] 李学松[1,2] 韩文科[1,2] 何志嵩[1,2] 金杰[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研究中心,北京100034

出　　处：《北京大学学报（医学版）》2015年第4期628-633,共6页Journal of Peking University:Health Sciences

摘　　要：目的：分析根治性膀胱全切术后发生肠梗阻的相关危险因素。方法：回顾北京大学第一医院泌尿外科2005年1月至2014年8月期间接受根治性膀胱全切手术的患者共749例,分析患者的临床特征与术后肠梗阻之间的相关性。排除9例接受原位回肠新膀胱的患者,共740例患者入选,其中男性596例,女性144例。患者中位年龄67岁,中位体重指数23.0 kg/m^2,共有82例患者（11.1%）术后发生肠梗阻。根据术后是否发生肠梗阻,将患者分为术后无肠梗阻组和术后肠梗阻组。结果：术后发生肠梗阻患者的年龄较大（中位年龄68岁vs.67岁,P=0.025）,体重指数偏低（中位体重指数23.2 kg/m^2vs.23.9 kg/m^2,P=0.006）;相对于接受输尿管皮肤造口的患者,接受回肠膀胱尿流改道的患者肠梗阻发生率更高[13.2%（66/500）vs.6.7%（16/240）,P=0.008];行盆腔淋巴结清扫的患者肠梗阻发生率高于未行盆腔淋巴结清扫的患者[12.2%（77/632）vs.4.6%（5/108）,P=0.021]。发生肠梗阻的患者平均住院时间更长（中位住院时间24 d vs.17 d,P=0.000）。术后肠梗阻与性别、既往腹部手术史、术前血红蛋白和肌酐水平、美国麻醉师协会（American Society of Anesthesiologists,ASA）评分、手术时间、出血量、异体输血、开放或腹腔镜手术、术后入监护室、肿瘤分期等因素均无相关性。多因素回归分析显示,年龄（OR值1.185,95%置信区间1.036~1.355,P=0.013）、体重指数（OR值0.605,95%置信区间0.427~0.857,P=0.005）、尿流改道方式（OR值2.422,95%置信区间1.323~4.435,P=0.004）、盆腔淋巴结清扫（OR值2.798,95%置信区间1.069~7.322,P=0.036）和术后肠梗阻的发生具有相关性。结论：根治性膀胱全切术后肠梗阻的发生与年龄和体重指数存在相关性,高龄和低体重指数的患者发生术后肠梗阻的危险性增加;接受回肠膀胱尿流改道和盆腔淋巴结清扫的患者术后肠梗阻的发生率高于接受Objective： To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus. Methods： In the retrospective study,749 patients who received radical cystectomy from January 2005 to August 2014 were reviewed,of whom,9 who received orthotopic ileal neobladder were excluded. Of the 740 patients,82（ 11. 1%） developed postoperative paralytic ileus. The correlation between the clinical characters and the occurrence of postoperative paralytic ileus was identified. Results： The postoperative paralytic ileus was significantly correlated with the patient＇s age（ 68 vs. 67,P = 0. 025）,body mass index（ 23. 0 kg / m^2 vs. 24. 1 kg / m^2,P = 0. 008）,different urinary diversion reconstruction methods [13. 2%（ 66 /500） for ileal conduit and7. 3%（ 16 /240） for cutaneous ureterostomy,P = 0. 008] and pelvic lymph node dissection [12. 2%（ 77 /632） vs. 4. 6%（ 5 /108）,P = 0. 021]. The postoperative paralytic ileus caused a prolonged hospital stay and delayed recovery（ 24 d vs. 17 d,P = 0. 000）. There was no significant correlation between the postoperative paralytic ileus and the patients＇ gender,previous abdominal operations,preoperative hemoglobin and creatinine,American Society of Anesthesiologists score,operative time,estimated blood loss,transfusion requirement,laparoscopic and open surgery,ICU admission or tumor staging. On multivariate analysis,age（ hazard ratio 1. 185,95% confidence interval 1. 036- 1. 355,P = 0. 013）,body mass index（ hazard ratio 0. 605,95% confidence interval 0. 427-0. 857,P =0. 005）,different urinary diversion reconstruction methods（ hazard ratio 2. 422,95% confidence interval 1. 323- 4. 435,P = 0. 004） and pelvic lymph node dissection（ hazard ratio 2. 798,95% confidence interval 1. 069- 7. 322,P = 0. 036） were significantly correlated with the presence of the postoperative paralytic ileus. Conclusion： Increasing age,decreasing BMI,ileal conduiturinary diversion and pelvic l

关 键 词：肠梗阻 膀胱切除术 危险因素 淋巴结清除术 尿流改道术 

分 类 号：R737.14[医药卫生—肿瘤]