膀胱癌根治性膀胱切除加肠道原位新膀胱术患者围手术期致命性并发症分析

Analysis of life-threatening complications during perioperative period in patients undergoing radical cystectomy with orthotopic neobladder

目的探讨膀胱癌根治性膀胱切除加肠道原位新膀胱术患者围手术期出现致命性并发症的影响因素。方法回顾性分析206例膀胱癌根治性膀胱切除加肠道原位新膀胱术患者的临床资料，对年龄、手术出血量、病理分期、有效补充白蛋白情况、是否合并心血管疾病、是否合并糖尿病、手术持续时间、肠道准备情况等因素进行Logistic回归分析。结果206例膀胱癌根治性膀胱切除加肠道原位新膀胱术患者中，有22例患者在围手术期出现肠瘘、失血性休克、重症感染等致命性并发症，发生率为10．7％，其中9例死亡，死亡率为4．4％。多因素Logistic回归分析结果显示，年龄、有效补充白蛋白情况、手术时间、是否合并糖尿病为膀胱癌根治术患者围手术期出现致命性并发症的独立影响因素（均P〈0．05），即高龄、未及时有效补充白蛋白、手术持续时间长和合并糖尿病是膀胱癌根治术患者围手术期出现致命性并发症的危险因素。结论高龄、未及时有效补充白蛋白、手术持续时间长和合并糖尿病是膀胱癌根治性膀胱切除加肠道原位新膀胱术患者围手术期出现致命性并发症的高危因素，应引起重视。

Objective To investigate the factors influencing life-threatening complications during perioperative period in patients undergoing traditional cystectomy with orthotopic neobladder. Methods To retrospectively analyze the clinical data of 206 cases who underwent radical cystectomy with orthotopic neobladder. Logistic regression analysis was used to analyze the significance of the factors such as age, amount of bleeding, pathological stage, effective supplement of albumin, cardiovascular disease, diabetes mellitus, operation duration, intestinal preparation, etc., on the occurrence of severe complications. Results Among the 206 patients who underwent radical cysteetomy with orthotopic neobladder, 22 cases （10.7%） had life-threatening complications （intestinal fistula, hemorrhagic shock, severe infection ） during the perioperative period, and 9 cases died （mortality rate 4.4% ）. Logistic regression analysis showed that the elderly age, long operation duration, lack of effective supplement of albumin, diabetes mellitus are independent factors influencing the occurrence of life-threatening complications during the perioperative period of radical cystectomy with orthotopic ileal neobladder （P〈0.05 for all）, and are risk factors positively correlated with the severe complications. Conclusion The elderly age, long operation duration, lack of effective supplement of albumin, and diabetes mellitus are risk factors of the occurrence of life-threatening complications during the perioperative period in patients undergoing radical cystectomy with orthotopic ileal neobladder, therefore, attention should be paid to this issue.