根治性膀胱切除术后肠梗阻并发症的危险因素分析  

Analysis of risk factors of intestinal obstruction complications after radical cystectomy

作　　者：王继鑫 宋鸿文 王玉杰[1] 木拉提·热夏提[1] 王文光[1] WANG Jixin;SONG Hongwen;WANG Yujie;Mulati·Rexiati;WANG Wenguang(The First Department of Urology,the First Affiliated Hospital of Xinjiang Medical University,Xinjiang Clinical Medical Research Center of Urogenital Diseases,Urumqi 830054,Xinjiang,China)

机构地区：[1]新疆医科大学第一附属医院泌尿外一科新疆泌尿男生殖系疾病临床医学研究中心,新疆乌鲁木齐830054

出　　处：《中国现代医生》2023年第12期53-57,共5页China Modern Doctor

摘　　要：目的探讨根治性膀胱切除术后发生肠梗阻的相关危险因素。方法分析2010年1月至2021年8月因膀胱肿瘤接受根治性膀胱切除术患者184例,根据是否发生术后肠梗阻分为肠梗阻组(n=153)和无肠梗阻组(n=31),应用单因素和多因素分析两组患者的各项因素。结果术后肠梗阻组患者的术中出血量更多(≤400ml vs.>400ml,P=0.013),术后血钾(3.85±0.59mmol/L vs.3.59±0.67mmol/L,P=0.032)和白蛋白(29.29±4.26g/L vs.26.80±4.29g/L,P=0.003)更低及术后下床时间较晚(≤48h vs.>48h,P=0.023)。两组患者的年龄、体质量指数(body mass index,BMI)、性别、民族、腹部手术史、是否患有高血压、糖尿病,是否贫血,手术方式及尿流改道方法,术中是否输血,手术时间及肿瘤病理分期和盆腔淋巴结是否转移比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示:患者术中出血量多(OR=2.685,95%CI:1.076~6.700,P=0.034)、术后白蛋白低(OR=0.905,95%CI:0.822~0.997,P=0.042)、术后下床时间晚(OR=4.264,95%CI:1.198~15.180,P=0.025)是术后肠梗阻发生的危险因素。结论术中出血量、术后白蛋白及术后下床时间与根治性膀胱切除术后肠梗阻的发生具有相关性,尤其术中出血量>400ml、术后白蛋白低于30g/L和术后卧床时间>48h时应高度重视肠梗阻的发生。Objective To investigate the risk factors of intestinal obstruction after radical cystectomy.Methods The clinical data of 184 patients who underwent radical cystectomy for bladder tumor from January 2010 to August 2021 were analyzed retrospectively.According to the occurrence of postoperative intestinal obstruction,patients were divided into intestinal obstruction group(n=153)and non-intestinal obstruction group(n=31),the single and multiple factors were used to analyze the factors of the two groups of patients.Results The patients with postoperative intestinal obstruction had more intraoperative blood loss(≤400ml vs.>400ml,P=0.013),lower serum potassium(3.85±0.59mmol/L vs.3.59±0.67mmol/L,P=0.032)and albumin(29.29±4.26g/L vs.26.80±4.29g/L,P=0.003)and later time to get out of bed(≤48h vs.>48h,P=0.023).There was no significant difference in age,body mass index(BMI),sex,nationality,history of abdominal operation,hypertension,diabetes,anemia,mode of operation and urinary diversion,blood transfusion during operation,operation time,pathological stage of tumor and pelvic lymph node metastasis between the two groups(P>0.05).Multivariate Logistic regression analysis showed that patients with high intraoperative blood loss(OR=2.685,95%CI:1.076-6.700,P=0.034),low postoperative albumin(OR=0.905,95%CI:0.822-0.997,P=0.042),late time to get out of bed after operation(OR=4.264,95%CI:1.198-15.180,P=0.025)and risk factors of postoperative intestinal obstruction.Conclusion Intraoperative blood loss,postoperative albumin and postoperative time out of bed are related to the occurrence of intestinal obstruction after radical cystectomy,especially when intraoperative blood loss is greater than 400ml,postoperative albumin is lower than 30g/L and postoperative bed rest time is more than 48 hours,so should attach great importance to the occurrence of intestinal obstruction.

关 键 词：膀胱肿瘤 膀胱切除术 肠梗阻 

分 类 号：R737[医药卫生—肿瘤]