膀胱癌根治术后远期代谢性酸中毒并发症的防治

Prevention and treatment of long-term complication of metabolic acidosis after radical resection of bladder cancer

目的：随访观察膀胱癌根治术患者远期并发症，总结代谢性酸中毒的发生情况及临床特点，制定防治策略。方法：回顾性分析我院2008年1月～2013年6月实施膀胱癌根治术37例患者的临床资料，其中开放手术26例，腹腔镜手术11例。研究术后3个月代谢性酸中毒的发生情况。结果：共发现代谢性酸中毒9例（9／37，24．3％），其中原位回肠膀胱术6例（6／21，28．6％），2例较为严重（pH值〈7．20）；原位乙状结肠膀胱术1例（1／4，25．0％）；回肠通道术2例（2／12，16．7％）。9例酸中毒患者尿液检查均合并尿路感染，其中7例合并低血钾（2．25～3．18mmol／L），6例合并不同程度肾功能不全（130～465μmo／L），仅1例合并高血氯（〉120mmol／L）。9例患者均采用保守治疗，通过留置尿管、利尿、应用抗生素、静脉滴注碳酸氢钠或口服碳酸氢钠片，均在1周内治愈。结论：肠代膀胱术后远期代谢性酸中毒并发症常常难以避免，但结果多不严重，并可通过优化手术方式，预防尿路感染，促进储尿囊的排空，从而降低其发生。治疗上多以保守治疗为主。

Objective： To sum up clinical characteristics of metabolic acidosis and make the prevention strategies through following up long-term complications of radical resection of bladder cancer. Method： A retrospective analysis of 37 patients with radical resection of bladder cancer from January 2008 to June 2013 was taken. A total of 26 patients converted to open surgery during the procedure, and 11 patients underwent laparoscopic surgery. We investigated the occurrence of metabolic acidosis three months after operation. Result： Nine patients were found metabolic acidosis （9/37, 24. 3%） including six cases undergoing orthotopic ileal neobladder （6/21, 28.6%）, one case undergoing orthotopic sigmoid neobladder （1/4, 25.0%）, two cases undergoing ileal conduit （2/12, 16.7%）. Two patients undergoing orthotopic ileal neobladder were serious （pHi7.20）. All these nine patients were complicated with urinary tract infection by examination of urine. Seven of them were found hypokal- emia （2.25-3.18 mmol/L）, and six cases were complicated with varying degrees of renal insufficiency （130 465 μmo/L）. Hyperchloremia （〉120 mmol/L） was only seen in one patient. All these nine cases recovered well after one-week conservative treatment including indwelling the urinary catheter, diuretics, antibiotics, intravenous infu- sion of sodium bicarbonate solution or oral taking sodium bicarbonate tablets. Conclusion： Although metabolic complications of intestinal neobladder in long term is inevitable, the result is not serious. Some strategies including optimizing operation method, prevention of urinary tract infection, promoting the allantoic emptying storage can decrease the occurrence of metabolic acidosis and treatment depends largely on conservative treatment.