回肠代膀胱术后不同膀胱冲洗方法的比较

Comparison of Different Bladder Irrigation Methods after Ileal Neobladder

目的探讨一种能减少回肠代膀胱术后早期并发症的新的膀胱冲洗方法。方法将45例行回肠代膀胱术后的患者按不同的膀胱冲洗方法分为3组:A组、B组、C组,每组15例。A组采用持续膀胱冲洗法,B组采用间断膀胱冲洗法,C组采用持续+间断膀胱冲洗法。观察3组患者尿白细胞计数≥1×104 L-1、尿细菌计数≥8 000μL-1(尿白细胞计数≥1×104 L-1为尿路感染;尿沉渣细菌定量计数:细菌计数≥8 000μL-1为尿路感染的阳性参考值)及引流管阻塞、术后并发症发生的情况。结果 C组尿白细胞计数≥1×104 L-1、尿细菌计数≥8 000μL-1所占比例均明显低于A组、B组(均P<0.05),A组尿白细胞计数≥1×104 L-1、尿细菌计数≥8 000μL-1所占比例与B组比较差异均无统计学意义(P>0.05)。C组引流管阻塞、膀胱造瘘口漏尿及切口感染发生率均明显低于A组、B组(均P<0.05),C组肠梗阻发生率明显低于A组(均P<0.05),C组肠梗阻发生率与B组比较差异无统计学意义(P>0.05),B组引流管阻塞、切口感染及肠梗阻发生率均明显低于A组(均P<0.05),B组膀胱造瘘口漏尿与A组比较差异无统计学意义(P>0.05)。结论对行回肠代膀胱术后的患者采用持续+间断膀胱冲洗法可降低术后切口感染、尿路感染的发生率。

Objective To explore a new bladder irrigation method for reducing early postopera- tive complications of ileal neobladder. Methods Forty-five patients who ileal neobladder postop- erative were treated with continuous bladder irrigation alone（group A） , intermittent bladder irri- gation alone（group B）,or the combination of both methods（group C）,with 15 patients in each group. Urine white blood cell count ≥1 × 10^4 L^-1 （white blood cell count ≥1 × 10^4 L^-1 as the uri- nary tract infection）, urine bacterial count ≥8 000μL-1 （urine sediment bacterial quantitative count ≥8 000μL-1 as the positive reference value for urinary tract infection）, drainage tube ob- struction and postoperative complications were observed in all patients. Results Urine white blood cell count 1 × 10^4 L-1 and urine bacterial count ≥8 000μL-1 in group C were significantly less than those in group A and group B（all P〈0. 05） ,but there were no obvious differences be- tween group A and group B（P〉0.05）. The incidences of drainage tube obstruction, urinary leak- age from the cystotomy and wound infection in group C were significantly lower than those in group A and group B（all P〈0.05）. The incidence of intestinal obstruction in group C was signifi- cantly lower than that in group A（P〈0.05） ,but was not obviously different from that in group B （P〈0. 05）. The incidences of drainage tube obstruction, incisional infection and intestinal ob- struction in group B were significantly lower than those in group A（all P〈0.05） ,but there were no obvious differences in urinary leakage from the cystotomy between the two groups（P〉0.05）. Conclusion The combined method of continuous bladder irrigation and intermittent bladder irri- gation can reduce postoperative wound infection,urinary tract infection in patients with following ileal neobladder reconstruction.