根治性膀胱全切手术及尿流改道方式对高龄患者围手术期并发症的影响

doi:10.3969/j.issn.1671-167X.2016.04.013

摘要/Abstract

摘要：

目的：分析根治性膀胱全切的不同手术方式对高龄患者围手术期并发症的影响。方法：回顾北京大学第一医院泌尿外科2003年1月至2015年1月期间接受根治性膀胱全切手术的患者共1 432例，年龄大于75岁的高龄患者239例（中位年龄78岁），其中74例患者（31.0%）出现了围手术期并发症。根据手术方式的不同患者可分为回肠膀胱组和输尿管皮肤造口组，回肠膀胱组包括经腹腹腔镜和经腹开放膀胱全切回肠膀胱术两种术式,输尿管皮肤造口组包括经腹开放、经腹膜外开放、经腹腹腔镜膀胱全切输尿管皮肤造口3种术式,比较不同术式对高龄患者围手术期并发症的影响。结果：单因素分析结果显示，高龄患者出现围手术期并发症的相关因素包括年龄（P=0.012）、美国麻醉师协会（American Society of Anesthesiologists，ASA）评分（P=0.001）、淋巴结分期（P=0.043）和手术方式。有围手术期并发症发生的患者住院时间明显延长（中位住院时间34 d vs. 21 d，P=0.002）。不同手术方式中，回肠膀胱组的围手术期并发症发生率高于输尿管皮肤造口术组（P=0.013），但经腹腹腔镜和经腹开放膀胱全切回肠膀胱术两种术式的围手术期并发症发生率差异无统计学意义（P=0.836）；经腹开放、经腹膜外开放、经腹腹腔镜膀胱全切输尿管皮肤造口3种术式之间并发症的发生率差异有统计学意义（P=0.022）。多因素回归分析显示，年龄大于85岁（OR=4.856，95% CI：1.465~16.103，P=0.010）、ASA评分（P=0.008）和不同手术方式（P=0.016）与高龄患者围手术期并发症的发生存在相关性。结论：高龄患者接受根治性膀胱全切手术的围手术期并发症发生与患者年龄、术前ASA评分和手术方式存在相关性，经腹膜外开放膀胱全切输尿管皮肤造口术的围手术期并发症发生率低，对于高龄患者是一种合适的手术方案。

关键词: 膀胱切除术, 尿道改流术, 输尿管造口术, 围手术期并发症, 老年人

Abstract:

Objective：To analyze the impact of different surgical methods on perioperative complication rate after radical cystectomy in patients over 75 years of age. Methods: A retrospective study reviewed 1 432 patients who received radical cystectomy from January 2003 to January 2015. A total of 239 patients were ≥75 years (median age: 78 years), of whom, 74 patients (31.0%) suffered one or more perioperative complications. According to the different operation methods, patients could be divided into ileal conduit group and cutaneous ureterostomy group. The ileal conduit group included laparoscopic and open radical cystectomy with ileal conduit. The cutaneous ureterostomy group included transperitoneal laparoscopic, transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy. Results: Perioperative complications were significantly associated with the patient’s age (P=0.012), American Society of Anesthesiologists (ASA) score (P=0.001), node staging (P=0.043), and different surgical methods. Perioperative complications caused a prolonged hospital stay and delayed recovery (34 d vs. 21 d, P=0.002). For different surgical methods, the perioperative complication rate of ileal conduit was higher than cutaneous ureterostomy (P=0.013). However, there were no significant differences between transperitoneal laparoscopic and open radical cystectomy with ileal conduit in perioperative complication rate (P=0.836). The perioperative complication rate was statistically significant among transperitoneal laparoscopic, transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy (P=0.022). On multivariate analysis, age (hazard ratio=4.856, 95% CI: 1.465-16.103, P=0.010), ASA score (P=0.008), and different surgical methods (P=0.016) were significantly associated with the perioperative complication rate. Conclusion: The perioperative complication rate after radical cystectomy in elderly patients was associated with the patients’ age, ASA score, and different surgical methods. Patients who received extraperitoneal open radical cystectomy with cutaneous ureterostomy suffered fewer perioperative complications, which was an appropriate choice for elderly patients.

Key words: Cystectomy, Urinary diversion, Ureterostomy, Perioperative complication, Aged

中图分类号:

R737.14

孟一森，王宇，范宇，苏杨，刘振华，虞巍，谌诚，周利群，张骞，何志嵩，金杰. 根治性膀胱全切手术及尿流改道方式对高龄患者围手术期并发症的影响[J]. 北京大学学报(医学版), 2016, 48(4): 632-637.

MENG Yi-sen, WANG Yu, FAN Yu, SU Yang, LIU Zhen-hua, YU Wei, CHEN Cheng, ZHOU Li-qun, ZHANG Qian, HE Zhi-song, JIN Jie. Impact of different surgical methods of radical cystectomy on the perioperative complications in patients over 75 years[J]. Journal of Peking University(Health Sciences), 2016, 48(4): 632-637.

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