摘要
目的:探讨腹腔镜下根治性膀胱切除术手术过程及围手术期的并发症发生情况。方法:回顾腹腔镜下根治性膀胱切除术49例资料,分析围手术期的并发症和死亡率,以及手术时间、术中出血及术后住院等情况。围手术期并发症定义为手术30天内发生的并发症,按Clavien分级系统将并发症分为5级。结果:平均手术时间418min,平均出血514 mL,输血率为36.7%,平均输血量578 mL,术后平均住院时间20 d。尿流改道方式上,回肠膀胱术27例,Studer原位新膀胱术16例,输尿管皮肤造口术6例。围手术期并发症发生率34.7%(17例),1～2级并发症发生率24.5%(12例),包括麻痹性肠梗阻、尿路感染、下肢深静脉血栓、肺炎等。3级及以上并发症10.2%(5例),围手术期死亡率1例。回肠膀胱术与Studer原位新膀胱术在手术时间、出血量、输血率、术后住院时间及并发症发生率方面差异均无统计学意义。结论:腹腔镜下根治性膀胱切除术仍有较高的并发症发生率,常见并发症为麻痹性肠梗阻、尿路感染等,需严格把握手术指证,采取相应措施积极预防。Studer原位新膀胱术相对于回肠膀胱术并未增加手术时间、出血及并发症发生率。
Objective： To evaluate operation process and perioperative complications of patients who underwent laparoscopic radical cystectomy（LRC）.Methods：The clinical data of 49 cases of LRC from October 2004 to June 2010 were reviewed retrospectively.Perioperative complications and mortality were analyzed,and so were the operative time,blood loss and postoperative hospital stay.Perioperative complications were defined as any adverse event within 30 days of surgery.All complications were graded according to an established five-grade modification of the original Clavien system.Results：The mean operation time was 418 minutes,the mean blood loss was 514 mL,the transfusion rate was 36.7%,the mean transfusion volume was 578 mL,and the average postoperative hospital stay was 20 d.For urinary diversion,ileal conduits were constructed in 27 patients（55.1%）,ileal neobladders in 16 patients（32.7%）,and ureterocutaneostomies in 6 patients（12.2%）.A total of 17 patients（34.7%） developed at least one perioperative complication.Complications of grades 1-2 occurred in 12 patients（24.5%）,which included subileus,urinary tract infections,deep venous thrombosis of the lower limbs,pneumonia,etc.Complications of grades 3-5 occurred in 5 patients（10.2%）,and one patient died of pulmonary embolism.Ileal neobladders and ileal conduits were similar at the operation time,blood loss,transfusion rates,postoperative hospital stay and morbidity of perioperative complications.Conclusion：Morbidity of perioperative complications following LRC was still high.The most frequent complications were subileus and urinary tract infections.The surgery should be performed on selected patients,and measures need to be taken to prevent these complications.Compared with ileal conduits,ileal neobladders did not increase the operation time,blood loss and morbidity.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2011年第4期544-547,共4页
Journal of Peking University:Health Sciences
关键词
膀胱切除术
腹腔镜
手术后并发症
手术中并发症
Cystectomy Laparoscopes Postoperative complications Intraoperative complications
