全膀胱切除术后回肠吻合口瘘的原因及处理  

Prevention and management of intestinal anastomotic fistula after total cystectomy

作　　者：孙宾 曹奇峰[3] 徐丁[3] 李殷南 高平发 王乾 SUN Bin;CAO Qifeng;XU Ding;LI Yinnan;GAO Pingfa;WANG Qian(Department of Urology, Xinhua Hospital Chongming Branch Affiliated to Shanghai JiaoTong University School of Medicine,Shanghai 202150, China)

机构地区：[1]上海交通大学医学院附属新华医院崇明分院泌尿外科,202150 [2]上海交通大学医学院附属新华医院崇明分院胃肠外科,202150 [3]上海交通大学医学院附属新华医院泌尿外科

出　　处：《现代泌尿生殖肿瘤杂志》2021年第1期21-24,共4页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的探讨全膀胱切除并回肠膀胱术(Bricker术)后回肠吻合口瘘的发生原因及其治疗方法。方法选取2001年1月至2020年12月间行全膀胱切除并Bricker术的244例患者的临床资料进行回顾性分析,并结合文献进行总结。结果在244例患者中,术后发生回肠吻合口瘘7例(2.87%)。1例因高龄、全身状况及营养状况差而死亡(术后11 d);2例行近端肠造口;2例术后2周行肠吻合口瘘口内半T管引流+腹腔引流;其余2例通过引流+全肠外营养(TPN)+生长抑素治疗后好转出院。结论回肠吻合口瘘是全膀胱切除并Bricker术后最严重的肠道并发症,及时正确的处理能够极大地减少患者痛苦,提高患者的生活质量。Objective To investigate the causes,prevention and treatmeant of intestinal anastomotic fistula after total cystectomy and ileal bladder replacement.Methods Clinical data of 244 patients who underwent total cystectomy and ileal bladder replacement between 2001 and 2020 were retrospectively analyzed and summarized based on related literature.Results In 244 cases,postoperative intestinal anastomotic fistula occurred in 7 cases(2.87%).One case died of intestinal fistula 11 days postopercrtively due to old age,systemic condition and poor nutrition.Two cases underwent proximal enterostomy for intestinal anastomotic fistula.Two cases underwent internal semi-T-tube drainage and abdomimal drainage within 2 weeks after intestinal anastomotic fistula surgery.The remaining two cases were discharged after treatment of drainage,total parenteral nutrition and somatostatin.Conclusions Intestinal anastomotic fistula is the most serious complication after total cystectomy and ileal bladder replacement.Timely and correct treatment can greatly reduce the pain of patients and improve the quality of life of patients.

关 键 词：膀胱癌 全膀胱切除 回肠代膀胱 回肠吻合口瘘 

分 类 号：R73[医药卫生—肿瘤]