膀胱癌根治术后肠梗阻危险因素分析

Risk factors for the development of postoperative ileus after radical cystectomy

目的探讨膀胱癌根治术后肠梗阻发生的相关危险因素。方法回顾分析2010年1月至2017年6月在本院行膀胱癌根治术患者103例,按术后发生肠梗阻,分为观察组和对照组。评估患者术后肠梗阻发生与临床特点的相关性。结果观察组患者中低白蛋白血症(<35g/L)发生率更高(71.4%vs.30.3%,P=0.003);观察组相比对照组有更高比例的既往腹部手术史(42.9%vs.19.1%,P=0.047)。但两组患者在性别、体重指数(BMI)、术前血红蛋白(Hb)、术中失血量、输血、手术方式、手术时间、尿流重建方式、术后血电解质比较,差异无统计学意义(P>0.05)。多因素logistic回归分析显示年龄(OR:6.444,95%CI:1.012~41.037,P=0.049)、低蛋白血症(OR:12.484,95%CI:2.777~56.115,P=0.001)是术后肠梗阻发生的危险因素。结论年龄和低蛋白血症与膀胱癌根治术后肠梗阻的发生呈显著相关性,对高龄患者应重点关注术后肠道恢复情况,同时应加强患者营养支持治疗。

Objective To identify the risk factors of postoperative ileus after radical cystectomy. Methods In the retrospective study, 103 patients who received radical cystectomy and urinary diversion from January 2010 to June 2017 were reviewed. All of these patients were divided into observation group or control group according to the ileus had happened or not. The correlation analysis of the clinical features and ileus was performed. Results Postoperative ileus occurred in 14(13.6%) of all these patients. Comparing to the control group, the patients with ileus had a significant older age(71.13 years vs. 67.78 years, P=0.043), higher rates of having the previous abdominal operation[42.9%(6/14) vs.19.1%(17/89), P=0.047], and more likely of having hypoalbuminemia (serum albumin level < 35 g/L)[71.4%(10/14) vs. 30.3%(27/89), P=0.003]. There was no significant correlation between the postoperative ileus and the patients'gender, BMI (body mass index), pre-operative hemoglobin, blood loss, transfusion requirement, laparoscopic and open surgery, operation time, urinary diversion method, and postoperative serum electrolyte. On multivariate analysis, the results showed that age(OR 6.444, 95%CI 1.012-41.037, P=0.049), hypoalbuminemia (serum albumin level<35 g/L)(OR 12.484, 95%CI 2.777-56.115, P=0.001) were significantly correlated with the development of the postoperative ileus. Conclusions Increasing age, decreasing serum albumin level are significantly correlated with the presence of postoperative ileus in patients undergoing radical cystectomy.