本文選題：膀胱切除術(shù) + 尿道改流術(shù)　； 參考：《北京大學(xué)學(xué)報(醫(yī)學(xué)版)》2016年04期

【摘要】：目的:分析根治性膀胱全切的不同手術(shù)方式對高齡患者圍手術(shù)期并發(fā)癥的影響。方法:回顧北京大學(xué)第一醫(yī)院泌尿外科2003年1月至2015年1月期間接受根治性膀胱全切手術(shù)的患者共1 432例,年齡大于75歲的高齡患者239例(中位年齡78歲),其中74例患者(31.0%)出現(xiàn)了圍手術(shù)期并發(fā)癥。根據(jù)手術(shù)方式的不同患者可分為回腸膀胱組和輸尿管皮膚造口組,回腸膀胱組包括經(jīng)腹腹腔鏡和經(jīng)腹開放膀胱全切回腸膀胱術(shù)兩種術(shù)式,輸尿管皮膚造口組包括經(jīng)腹開放、經(jīng)腹膜外開放、經(jīng)腹腹腔鏡膀胱全切輸尿管皮膚造口3種術(shù)式,比較不同術(shù)式對高齡患者圍手術(shù)期并發(fā)癥的影響。結(jié)果:單因素分析結(jié)果顯示,高齡患者出現(xiàn)圍手術(shù)期并發(fā)癥的相關(guān)因素包括年齡(P=0.012)、美國麻醉師協(xié)會(American Society of Anesthesiologists,ASA)評分(P=0.001)、淋巴結(jié)分期(P=0.043)和手術(shù)方式。有圍手術(shù)期并發(fā)癥發(fā)生的患者住院時間明顯延長(中位住院時間34 d vs.21 d,P=0.002)。不同手術(shù)方式中,回腸膀胱組的圍手術(shù)期并發(fā)癥發(fā)生率高于輸尿管皮膚造口術(shù)組(P=0.013),但經(jīng)腹腹腔鏡和經(jīng)腹開放膀胱全切回腸膀胱術(shù)兩種術(shù)式的圍手術(shù)期并發(fā)癥發(fā)生率差異無統(tǒng)計學(xué)意義(P=0.836);經(jīng)腹開放、經(jīng)腹膜外開放、經(jīng)腹腹腔鏡膀胱全切輸尿管皮膚造口3種術(shù)式之間并發(fā)癥的發(fā)生率差異有統(tǒng)計學(xué)意義(P=0.022)。多因素回歸分析顯示,年齡大于85歲(OR=4.856,95%CI:1.465~16.103,P=0.010)、ASA評分(P=0.008)和不同手術(shù)方式(P=0.016)與高齡患者圍手術(shù)期并發(fā)癥的發(fā)生存在相關(guān)性。結(jié)論:高齡患者接受根治性膀胱全切手術(shù)的圍手術(shù)期并發(fā)癥發(fā)生與患者年齡、術(shù)前ASA評分和手術(shù)方式存在相關(guān)性,經(jīng)腹膜外開放膀胱全切輸尿管皮膚造口術(shù)的圍手術(shù)期并發(fā)癥發(fā)生率低,對于高齡患者是一種合適的手術(shù)方案。
[Abstract]:Objective: to analyze the effects of radical cystectomy on perioperative complications of elderly patients. Methods: a total of 1432 patients undergoing radical cystectomy in the Department of Urology of No.1 Hospital of Peking University from January 2003 to January 2015 were reviewed, and 239 elderly patients older than 75 years old (median age 78 years old) were reviewed. 74 patients (31%) had perioperative complications. Patients with different surgical methods could be divided into the ileum bladder group and the ureterostomy group. The ileum and bladder group included two kinds of surgical procedures: abdominal laparoscopy and open bladder total resection of the cystectomy. The ureterostomy group was open through the abdomen, through the peritoneum, through the abdominal cavity. 3 methods of endoscopic bladder total ureteral orostomy were used to compare the effects of different surgical procedures on perioperative complications. Results: the results of single factor analysis showed that the factors associated with perioperative complications included age (P=0.012), American anesthesiologist Association (American Society of Anesthesiologists, ASA) score (P=0.00 1) lymph node staging (P=0.043) and surgical procedures. Patients with perioperative complications were significantly longer hospitalized (34 D vs.21 D, P=0.002). In different surgical methods, the peri operative complication rate in the ileum group was higher than that of the ureterostomy group (P=0.013), but abdominal laparoscopy and abdominal opening to the bladder There was no significant difference in the incidence of perioperative complications between the two methods of total resection of the ileum (P=0.836). The incidence of complications was statistically significant (P =0.022) between the open abdominal open, peritoneoscopic open ureterostomy (P =0.022). Multiple factor regression analysis showed that the age was greater than 85 years (OR =4.856,95%CI:1.465~16.103, P=0.010), ASA score (P=0.008) and different surgical methods (P=0.016) and the incidence of perioperative complications in elderly patients. Conclusion: the perioperative complications of elderly patients undergoing radical cystectomy are related to the age of the patients, the preoperative ASA score and the surgical methods are related to the peritoneum. The incidence of perioperative complications of external open radical cystectomy and ureterostomy is low, which is a suitable surgical procedure for elderly patients.
【作者單位】： 北京大學(xué)第一醫(yī)院泌尿外科北京大學(xué)泌尿外科研究所國家泌尿男性生殖系腫瘤研究中心;
【分類號】：R737.14

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