根治性膀胱切除术后早期再次手术原因分析

The Analysis of Early Re-operation After Radical Cystectomy and Urinary Diversion

目的探讨根治性膀胱切除术后早期再次手术的原因。方法回顾性分析1996年1月至2007年12月根治性膀胱切除术227例,其中术后早期(30 d内)再次手术患者17例(7.5%),男性14例,女性3例,平均年龄56岁。肠道相关的并发症6例,输尿管代膀胱瘘合并阴道瘘1例,切口感染6例,切口裂开4例。结果机械性肠梗阻2例,行小肠部分切除端端吻合术;早期粘连性肠梗阻1例,行肠粘连松解术;回肠吻合口瘘合并回肠新膀胱尿瘘1例,行回肠部分切除再吻合和回肠新膀胱修补术;乙状结肠吻合口瘘1例,行结肠造瘘术后出现小肠瘘经6次手术治愈;直肠瘘合并尿瘘1例,行结肠造口和输尿管代膀胱再吻合术;输尿管代膀胱吻合口瘘并阴道尿瘘1例,经充分引流后无效,行输尿管代膀胱再吻合术;伤口感染6例、伤口裂开4例,均经二次清创缝合治愈。失访2例,15例随访1个月～10 a,平均42个月。术后肿瘤转移死亡2例,肾功能恶化需长期血液透析1例,余12例病情稳定,生活质量满意。结论根治性膀胱切除术后早期(30 d内)易出现并发症需再次手术,围手术期及时再次手术可减轻患者痛苦和改善生活质量。

Objective To assess the cause of re-operation after radical cystectomy and urinary diversion. Metth- ods The clinical data of 227 cases of radical cystectomy from January 1996 to December 2007 were reviewed retro- spectively. Seventeen patients required a second abdominal procedure （7.5%） within 30-day of radical cystecto- my. There were 14 male patients and 3 female patients. The mean age was 56 years old. Six patients with intestinal complications, 1 patient with urine fistula, 6 patients with wound infections, 4 patients with wound debiscences were observed. Results Two patients with obstructive ileus required partial resection and end--to-end anastomosis, 1 patient with adhesive ileus needed enterolysis, 1 patient with ileal anastomotic fistula and ile^d neobladder urinary fistula was performed by partial resection and end-to-end anastomosis and neoplasty, 1 patient with fistula of sigmoid colon required colostomy and was cured after six operations, 1 patient with rectal fistula needed colostomy and re- anastomosis of ureter, 1 patient with stomal leakage and vagina leakage was performed by re^mastomosis of ureter and ilea conduit, 6 patients with wound infections and 4 patients with wound dehiscences required debridement and were cured. Fifteen patients were followed with an average of 42 months and 2 patients were lost. Two patients died from cancer, 1 patient need long-term dialysis because of renal failure, and 12 patients had a good quality of life without complications. Conclusion Radical cystectomy is associated with early complications within 30-day of opera- tion, and appropriate re-exploration promptly may improve the efficacy of the operation and the quality of patients.