关键词: 肠梗阻, 膀胱切除术, 危险因素, 淋巴结清除术, 尿流改道术

Abstract:

Objective： To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus. Methods: In the retrospective study, 749 patients who received radical cystectomy from January 2005 to August 2014 were reviewed, of whom, 9 who received orthotopic ileal neobladder were excluded. Of the 740 patients, 82 (11.1%) developed postoperative paralytic ileus. The correlation between the clinical characters and the occurrence of post-operative paralytic ileus was identified. Results: The postoperative paralytic ileus was significantly correlated with the patient’s age (68 vs. 67, P=0.025), body mass index (23.0 kg/m² vs.24.1 kg/m², P=0.008), different urinary diversion reconstruction methods ［13.2%(66/500) for ileal conduit and 7.3%(16/240) for cutaneous ureterostomy, P=0.008］ and pelvic lymph node dissection ［12.2%(77/632) vs.4.6% (5/108), P=0.021］.The postoperative paralytic ileus caused a prolonged hospital stay and delayed recovery (24 d vs. 17 d, P=0.000). There was no significant correlation between the postoperative paralytic ileus and the patients’ gender, previous abdominal operations, preoperative hemoglobin and creatinine, American Society of Anesthesiologists score, operative time, estimated blood loss, transfusion requirement, laparoscopic and open surgery, ICU admission or tumor staging. On multivariate analysis, age (hazard ratio 1.185, 95% confidence interval 1.036-1.355, P=0.013), body mass index(hazard ratio 0.605, 95% confidence interval 0.427-0.857, P=0.005), different urinary diversion reconstruction methods (hazard ratio 2.422, 95% confidence interval 1.323-4.435, P=0.004) and pelvic lymph node dissection (hazard ratio 2.798, 95% confidence interval 1.069-7.322, P=0.036) were significantly correlated with the presence of the postoperative paralytic ileus. Conclusion: Increasing age, decreasing BMI, ileal conduiturinary diversion and pelvic lymph node dissection were significantly correlated with the presence of postoperative paralytic ileus in patients undergoing radical cystectomy.

Key words: Intestinal obstruction, Cystectomy, Risk factors, Lymph node excision, Urinary diversion