全膀胱切除和原位新膀胱术并发症的预防和处理

Prevention and management of surgical complications after total cystectomy and neobladder

目的:报告全膀胱切除+原位新膀胱术后并发症的预防和处理经验。方法:对全膀胱切除+原位新膀胱术患者的并发症和处理结果进行回顾性总结,分析手术改良措施对并发症的预防作用。结果:对全膀胱切除+原位新膀胱术进行多处改良,119例术后共发生并发症20例,其中切口全层裂开5例,再次缝合治愈;输尿管吻合口漏和狭窄各1例,经再次开放手术治愈;输尿管口粘连8例,经内镜下手术治愈;不完全性肠梗阻3例,经保守治疗得到控制;慢性代谢性酸中毒和低钾血症2例,需长期服药纠正。无膀胱输尿管返流和肾功能不全病例。结论:经改良手术技术和采取预防措施后,全膀胱切除+原位新膀胱术的并发症减少,再次手术可纠正大部分外科并发症。

Objective：To report our experience on prevention and management of surgical complications after total cystectomy and neobladder. Methods： Surgical complications occurred in patients after total cystectomy and neobladder for invasive bladder cancer were analyzed retrospectively. The impact of modification in surgical techniques of cystectomy and neobladder on prevention of surgical complications was also analyzed. Results： Modificaions had been made in many aspects for total cystectomy and neobladder. Complications occurred in 20 of 119 patients. The complications including wound dehiscence in 5 cases, ureteral anastomotic leakage and stenosis in 1 case respectively, and conglutination of ureter orifices in 8 cases, were corrected surgically without sequela. Three patients with ileus and 2 patients with metabolic acidosis and hypokalemia were managed conservatively and successfully. Ureteral reflux and renal function failure did not develop in any patient. Conclusions：After Modified the com plications after total cystectomy and neobladder decreased. Surgical complication could be corrected by re-operation.