發(fā)布時(shí)間：2018-05-17 15:31

  本文選題：膀胱癌 + 全膀胱切除術(shù)　； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究背景及目的 研究全膀胱切除尿路重建術(shù)后早期并發(fā)癥及其相關(guān)風(fēng)險(xiǎn)因素，并據(jù)此為醫(yī)護(hù)人員對(duì)患者進(jìn)行術(shù)后并發(fā)癥相關(guān)危險(xiǎn)因素的管控提供參考。 膀胱癌是泌尿生殖系統(tǒng)最常見的惡性腫瘤之一，2008年全國膀胱癌發(fā)病率為7.49/10萬，并呈逐年上升趨勢。據(jù)全國腫瘤防治研究辦公室最新發(fā)布的數(shù)據(jù)流行病學(xué)資料顯示，大連地區(qū)是我國膀胱癌的高發(fā)地區(qū)，其膀胱癌發(fā)病率為11.85/10萬，居全國之首。全膀胱切除尿路重建術(shù)是治療肌層浸潤性膀胱腫瘤以及復(fù)發(fā)性膀胱腫瘤的標(biāo)準(zhǔn)方法，通過治療可以使患者的10年生存率明顯提高。然而該手術(shù)是泌尿外科最為復(fù)雜的手術(shù)之一，加之患者普遍年齡較高，合并諸多基礎(chǔ)疾病等因素導(dǎo)致術(shù)后時(shí)常出現(xiàn)并發(fā)癥，不利于患者順利康復(fù)。國外不少研究結(jié)果顯示針對(duì)導(dǎo)致術(shù)后產(chǎn)生并發(fā)癥的危險(xiǎn)因素進(jìn)行積極管控可以顯著減少相應(yīng)并發(fā)癥的出現(xiàn)。然而，目前國內(nèi)相關(guān)領(lǐng)域的研究資料還相對(duì)欠缺，不利于手術(shù)的廣泛開展和術(shù)后并發(fā)癥的控制。本研究采用“手風(fēng)琴式”術(shù)后并發(fā)癥分級(jí)系統(tǒng)對(duì)大連醫(yī)科大學(xué)附屬第二醫(yī)院泌尿外科2001年以來因膀胱癌行膀胱全切尿流改道術(shù)的67位患者術(shù)后早期并發(fā)癥進(jìn)行回顧性分析，并針對(duì)所出現(xiàn)的并發(fā)癥進(jìn)行相關(guān)風(fēng)險(xiǎn)因素的探究，以期為今后預(yù)防及減少同類手術(shù)相關(guān)并發(fā)癥提供參考。 方法 本課題采集了大連醫(yī)科大學(xué)附屬第二醫(yī)院泌尿外科2001年以來因膀胱癌行膀胱全切尿流改道術(shù)的67位患者的臨床資料進(jìn)行回顧性分析，以“手風(fēng)琴式”術(shù)后并發(fā)癥分級(jí)系統(tǒng)對(duì)術(shù)后早期出現(xiàn)的并發(fā)癥進(jìn)行分級(jí)，再按照有關(guān)文獻(xiàn)報(bào)道的分類依據(jù)對(duì)所出現(xiàn)的并發(fā)癥進(jìn)行歸類統(tǒng)計(jì)。之后所有病例分為并發(fā)癥組和無并發(fā)癥組進(jìn)行組間單因素分析，篩選出的相關(guān)危險(xiǎn)因素經(jīng)整合后進(jìn)行多因素logistic回歸分析。 結(jié)果 在67例患者中出現(xiàn)并發(fā)癥者42例，占62.7%，其中出現(xiàn)輕度并發(fā)癥24例，占并發(fā)癥組患者的57.1%；中度并發(fā)癥10例，占21.4%；重度并發(fā)癥8例，占19.1%。同時(shí)出現(xiàn)兩項(xiàng)及以上并發(fā)癥的患者為19例，占患者總數(shù)的23.4%。胃腸道相關(guān)并發(fā)癥的發(fā)生率最高，其次是低血容量及電解質(zhì)失衡相關(guān)并發(fā)癥，感染性并發(fā)癥亦不少見，其余并發(fā)癥分類項(xiàng)發(fā)生率相對(duì)較低。 單因素組間分析結(jié)果顯示導(dǎo)致術(shù)后并發(fā)癥的風(fēng)險(xiǎn)因素包括：年齡、吸煙史、白蛋白、谷草轉(zhuǎn)氨酶、谷丙轉(zhuǎn)氨酶、血壓、血糖、ASA等級(jí)、腫瘤分期、手術(shù)時(shí)間、術(shù)中失血量和術(shù)中輸血量。對(duì)上述危險(xiǎn)因素整合后經(jīng)多因素logistic回歸顯示：糖尿病、術(shù)前肝功能異常和術(shù)中出血量是引起術(shù)后并發(fā)癥的重要風(fēng)險(xiǎn)因素。 結(jié)論 1.膀胱全切尿流改道術(shù)后并發(fā)癥發(fā)生率較高，但重度并發(fā)癥及圍術(shù)期死亡率均較低，，因此本研究認(rèn)為該手術(shù)仍是我國治療肌層浸潤性膀胱腫瘤安全且有效的治療方式。 2.胃腸道并發(fā)癥、低血容量電解質(zhì)失衡相關(guān)并發(fā)癥、感染是術(shù)后早期最常見的并發(fā)癥。 3.糖尿病、術(shù)前肝功能異常和術(shù)中出血量是引起術(shù)后并發(fā)癥的重要風(fēng)險(xiǎn)因素。其次，高血壓、手術(shù)時(shí)間、手術(shù)方式、吸煙史亦是導(dǎo)致術(shù)后并發(fā)癥的相關(guān)危險(xiǎn)因素。 4.年齡和腫瘤分期不能作為術(shù)后早期并發(fā)癥的獨(dú)立危險(xiǎn)因素，其與術(shù)后早期并發(fā)癥的關(guān)系尚不明確。
[Abstract]:Background and purpose of research
To study the early complications and related risk factors of urinary tract reconstruction after total cystectomy, and to provide a reference for the medical and nursing staff to control the risk factors of postoperative complications.
Bladder cancer is one of the most common malignant tumors in the genitourinary system. The incidence of bladder cancer in China is 7.49/10 million in 2008 and is increasing year by year. According to the latest data epidemiological data published by the National Cancer Prevention and Control Research Office, the Dalian area is a high incidence area of bladder cancer in China, and the incidence of bladder cancer is 11.85/10 million. Total cystectomy is the standard method for the treatment of invasive bladder tumor and recurrent bladder tumor, which can improve the 10 year survival rate of the patients. However, this operation is one of the most complicated operations in the Department of urology. It is not conducive to the smooth recovery of the patients after the operation. Many foreign research results show that the active control of the risk factors causing complications after the operation can significantly reduce the occurrence of the corresponding complications. However, the research data in the domestic related fields are relatively deficient at present, which is not conducive to the extensive development of the operation and the development of the operation. Control of postoperative complications. This study reviewed the early complications of 67 patients in the Department of Urology of the Second Affiliated Hospital of Dalian Medical University since 2001 in the Department of Urology of the second hospital, affiliated with bladder cancer. In order to provide reference for future prevention and reduction of similar surgical complications.
Method
In this study, the clinical data of 67 patients in the Department of Urology of the Second Affiliated Hospital of Dalian Medical University since 2001 were reviewed and analyzed. The complications of the postoperative complications after the "accordion" complication classification system were classified according to the related literature. According to the classification of the complications, all the cases were divided into single factor analysis in the complication group and the non complication group, and the related risk factors were integrated and analyzed by multiple factor Logistic regression after integration.
Result
Among the 67 patients, there were 42 cases of complications, accounting for 62.7%, of which 24 cases had mild complications, 57.1% of the complications, 10 cases of moderate complications, 21.4%, and 8 cases of severe complications, and 19 patients with 19.1%., which had two and more complications, and the incidence of 23.4%. gastrointestinal complications was the highest. Followed by low blood volume and electrolyte imbalance related complications, infectious complications are not rare, the incidence of other complications classification is relatively low.
The risk factors of postoperative complications included age, smoking history, albumin, glutamic aminotransferase, alanine aminotransferase, blood pressure, blood sugar, ASA grade, tumor staging, operation time, intraoperative blood loss and intraoperative blood transfusion. The risk factors were integrated by multiple factor Logistic regression after integration of the risk factors: diabetes, surgery Abnormal liver function and intraoperative blood loss are important risk factors for postoperative complications.
conclusion
1. the incidence of complications after total bladder resection is high, but severe complications and perioperative mortality are low. Therefore, this study is still a safe and effective treatment for invasive bladder tumor in our country.
2. gastrointestinal complications, low volume electrolyte imbalance related complications, infection is the most common early postoperative complications.
3. diabetes, abnormal preoperative liver function and intraoperative bleeding are important risk factors for postoperative complications. Secondly, hypertension, operation time, mode of operation, and smoking history are also related risk factors for postoperative complications.
4. age and tumor staging are not independent risk factors for early postoperative complications, and their relationship with early postoperative complications is unclear.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.14

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