膀胱全切原位尿流改道术后早期并发症及危险因素分析  

The Early Complications and their Risk Factors Following Radical Cystectomy and Orthotopic Diversion

作　　者：黄应龙[1] 王剑松[1] 于跃平[2] 王海峰 丁明霞[1] 李宁[1] 李丹娜[1] 左毅刚[1] 

机构地区：[1]昆明医科大学第二附属医院泌尿外科,云南昆明650101 [2]云南省第二人民医院泌尿外科,云南昆明650021

出　　处：《广东医学》2017年第3期378-382,共5页Guangdong Medical Journal

基　　金：国家自然科学基金资助项目(编号:81460384)

摘　　要：目的探讨膀胱全切原位尿流改道术后早期并发症及相关危险因素。方法回顾性分析73例行膀胱全切原位尿流改道术患者的术后早期并发症发生情况,采用"手风琴式"并发症分级系统进行分析,并应用logistic回归分析研究其相关危险因素。结果 73例患者中出现早期并发症者42例(57.5%),共发生并发症77例次。其中轻度29例次(37.7%),中度44例次(57.1%),重度4例次(5.2%)。常见的早期并发症为感染相关并发症、胃肠道相关并发症以及尿漏。logistic多因素回归分析结果显示,与患者术后早期并发症发生有关的因素有体质指数(BMI)(OR=1.574,P=0.002)、手术失血量(OR=1.050,P=0.027)和CCI评分(OR=1.127,P=0.040)。结论膀胱全切原位尿流改道术后早期轻、中度并发症发生率较高。患者BMI、术中出血量和CCI评分与其密切相关。Objective To retrospectively review the risk factors associated with early complications following radical cystectomy and orthotopic diversion.Methods The clinical data of 73 patients who had undergone orthotopic diversion from January 2014 to December 2015 in the Second Affiliated Hospital of Kunming Medical University were analyzed.According to the Postoperative Complication Grading System,in- hospital complications were retrospectively analyzed and subdivided into different grades and categories.Multivariate logistic regression was applied for correlation analysis.Results Among the 73 patients,42（57.5%） developed at least 1 postoperative complication.In the total of 77 of early complications,29（37.7%） were minor complications,44（57.1%） were moderate complications and 4（5.2%） were major complications.The most common complications were infection- related events,gastrointistinal events and urine leakage.According to the logistic regression analysis,the risk factors leading to postoperative complications were BMI score（OR=1.574,P=0.002）,blood loss（OR=1.050,P=0.027） and CCI score（OR=1.127,P=0.040）.Conclusion The rate of severe and lethal complications following radical cystectomy and orthotopic diversion is acceptably low.The incidence of the early complications is correlated with BMI score,blood loss and CCI score.

关 键 词：根治性膀胱切除术 膀胱癌 原位尿流改道 并发症 

分 类 号：R687.4[医药卫生—骨科学]