胃造瘘技术在膀胱全切回肠代膀胱术后胃肠减压中的作用

Application of tube gastrostomy in radical cystectomy with ileal conduit:a retrospective, comparative study

目的探讨胃造瘘技术在膀胱全切回肠代膀胱手术中的应用及实际效果。方法回顾性分析2007年3月～2010年2月在中南大学湘雅二医院行膀胱全切回肠代膀胱手术的两种胃肠减压方式(胃造瘘组48例和经鼻留置胃管组50例)的患者资料,如胃肠道功能恢复时间、手术相关并发症及住院时间等,通过统计学分析评价两种胃肠减压方式对患者术后恢复及并发症所带来的影响,了解胃造瘘技术在该手术中的作用。结果两种术后胃肠减压方式在胃肠道恢复、胃肠道并发症、切口愈合及住院天数上无明显差别,但术后肺部感染率胃造瘘组较经鼻留置胃管组为低,有统计学意义(P<0.05)。结论胃造瘘技术成熟、安全、并发症低;在高龄患者或有潜在术后呼吸系统并发症风险的患者中,可以采用胃造瘘方式来进行胃肠减压来降低肺部并发症的发生。

Objective To evaluate the clinical results of tube gastrostomy in radical cystectomy and ileal conduit. Methods We retrospectively analyzed the data of 98 patients undergoing radical cystectomy and ileal conduit between March 2007 and February 2010. According to postoperative gastrointestinal decompression methods, the patients were divided into nasogastric decompression group （n=50） and tube gastrostomy group （n=48）, and the gastrointestinal recovery time, surgical complications and hospital stay were compared between them. Results No statistical difference was found in gastrointestinal recovery time, hospital stay, or surgical complications between the two groups, but the incidence of pulmonary infection was significantly lower in tube gastrostomy group than in nasogastric decompression group （P〈0.05）. Conclusion Tube gastrostomy is an easy, safe and effective means for gastric decompression after radical cystectomy with ileal conduit, especially suitable for elderly patients and those with potential pulmonary disorder.