根治性膀胱切除术后盆腔引流液蛋白丢失情况研究

Protein Loss from Pelvic Drainage after Radical Cystectomy

目的探讨根治性膀胱切除术后盆腔引流液蛋白丢失情况及其术后补充蛋白的重要性,并为临床治疗提供依据。方法选取2010年4月—2011年2月于本院由同一手术组医生施行根治性膀胱切除术、乙状结肠代膀胱术的患者17例,其中9例行开放根治性膀胱切除术(开放组),8例行腹腔镜下根治性膀胱切除术(腹腔镜组)。两组术后连续3 d给予20 g清蛋白支持治疗。检测患者术前血清总蛋白、血红蛋白水平;检测术后3 d内的盆腔引流液量、引流液蛋白定量、血清总蛋白及血红蛋白水平,并进行比较分析。结果术中开放组出血量为(768±191)ml,腹腔镜组为(412±62)ml;术中及术后开放组输血量为(600±200)ml,腹腔镜组为(350±93)ml;两组出血量及输血量比较,差异均有统计学意义(t=5.022,P=0.000;t=3.232,P=0.006)。开放组术后第1天和第2天血清总蛋白水平、术后第1天血红蛋白水平、术后第2天盆腔引流液量及术后第1天和第2天盆腔引流液蛋白丢失量与腹腔镜组比较,差异均有统计学意义(P<0.05)。对于影响术后盆腔引流液蛋白丢失的因素进行多元线性回归分析,仅手术方式进入回归方程(b=0.608,t=2.965,P=0.010)。结论根治性膀胱切除术后盆腔渗出液中丢失大量的蛋白质,及时补充蛋白对患者术后康复至关重要。腹腔镜膀胱切除术创伤小,恢复快,在应用上更具推广价值。

Objective To discuss the pelvic leakage and importance of protein therapy after radical cystectomy and to provide evidences for clinical treatment. Methods 17 patients underwent radical cystectomy and replacement of bladder by sigmoid by the same group of doctors from April 2010 to February 2011 were selected. Among the 17 patients, 9 cases were given open radical cystectomy （ open group） and 8 cases were given laparoscopic radical cystectomy （ laparoscopic： group） . The two groups were given supportive treatment of 20 g albumin for three days in a row after cvstectomv. Hemoglobin and serum albumin of the two groups were detected before treatment. Pelvic leakage volume, protein assay of leakage, serum albumin and hemoglobin were detected and compared between the two groups three days after cystectomy. Results The bleeding volume was （768 ± 191 ） ml and （412 ± 62） ml respectively in the open group and laparoscopic group. The blood transfusion volume was （600 ± 200） ml and （350 ± 93 ） ml respectively in the open group and laparoscopic group. The bleeding volume and blood transfusion volume between the two groups showed statistically significant difference （ t = 5. 022, P = 0. 000 ; t = 3. 232, P = 0. 006） . The levels of serum total protein one day and two days after cystectomy, the level of hemoglobin one day after cystectomy, the leakage volume two days after cystectomy and the protein loss volume through pelvic leakage showed statistically significant differences between open group and laparoscopic group （P 〈 0. 05） . Multiple linear regression analysis was performed on the factors influencing the protein loss through pelvic leakage, and only operation approach entered the equation （ b = 0. 608, t = 2. 965, P =0. 010）. Conclusion There are a lot of proteins lost after radical cystectomy and timely protein supplement is very important for the recovery of patients. Laparoscopic radical cystectomy for invasive bladder cancer is an efficient method with minimal invasion and rapid recovery and should be promoted in clinic.