机器人辅助腹腔镜根治性膀胱切除术后早期肠梗阻的风险因素分析  

Analysis of risk factors for postoperative early intestinal obstruction after robo-tassisted radical cystectomy

作　　者：丁佳蓉 朱逸琪 王良梅[1] 江波 谢尚训 张士伟[1] 杨荣[1] 郭宏骞[1] DING Jiarong;ZHU Yiqi;WANG Liangmei;JIANG Bo;XIE Shangxun;ZHANG Shiwei;YANG Rong;GUO Hongqian(Department of Urology,Nanjing Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,江苏南京210008

出　　处：《现代泌尿外科杂志》2022年第2期104-108,114,共6页Journal of Modern Urology

基　　金：国家自然科学基金(No.81772727)。

摘　　要：目的探讨机器人辅助腹腔镜根治性膀胱切除术(RARC)患者术后30 d内发生肠梗阻的危险因素。方法回顾性分析2018年1月-2021年3月因膀胱癌在南京大学医学院附属鼓楼医院行机器人辅助腹腔镜根治性膀胱切除术的258例患者的临床资料,根据患者术后是否发生肠梗阻分为梗阻组和未梗阻组。比较两组患者的临床资料,采用单因素和多因素Logistic回归分析探讨行RARC术后患者发生早期肠梗阻的危险因素。结果258例患者中43例术后发生了早期肠梗阻,发生率为16.7%。两组患者年龄、体重指数、美国麻醉医师协会(ASA)分级、手术方式、尿流改道方式、术中估计失血量比较差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、ASA分级、手术方式、尿流改道方式是行RARC术患者发生术后早期肠梗阻的独立危险因素(P<0.05)。结论RARC术后患者早期肠梗阻的发生受多因素影响,对于年龄≥65岁、ASA>2分的患者,改善围术期基础状况、加强术后管理,将有利于减少术后早期肠梗阻的发生。Objective To investigate the risk factors of intestinal obstruction within 30 days after robot-assisted radical cystectomy(RARC).Methods A retrospective analysis was performed on 258 patients who received RARC for bladder cancer in our hospital during Jan.2018 and Mar.2021.According to the occurrence of intestinal obstruction after operation,the patients were divided into obstruction group and non-obstruction group.Clinical characteristics of the two groups were compared,and the risk factors were analyzed with univariate and multivariate Logistic regression analysis.Results A total of 43 out of 258 patients suffered from postoperative ileus,with an incidence of 16.7%.There were significant differences in age,body mass index(BMI),ASA score,surgical methods,urinary diversion methods and estimated intraoperative blood loss between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age,ASA score,surgical methods and urinary diversion methods were the independent risk factors for early intestinal obstruction after RARC(P<0.05).Conclusion The incidence of early intestinal obstruction following RARC is related to multiple perioperative factors.For patients aged≥65 years and ASA score>2 points,improving the perioperative basic condition and strengthening postoperative management will be conducive to reducing the incidence of early postoperative intestinal obstruction.

关 键 词：膀胱癌 根治性膀胱切除术 术后肠梗阻 回归分析 危险因素 

分 类 号：R737.14[医药卫生—肿瘤]