胃肠减压在根治性膀胱切除术后应用的必要性评价

目的探讨根治性膀胱切除术后留置胃肠减压的必要性。方法回顾性分析211例行根治性膀胱切除术患者的临床资料,根据是否留置胃肠减压分为胃肠减压组（18例）和对照组（193例）,比较两组的临床效果和并发症情况。结果211例根治性膀胱切除术后有32例发生肠梗阻,占15.2%。其中胃肠减压组有4例发生肠梗阻（22.2%,4/18）,对照组有28例发生肠梗阻（14.5%,28/193）,两组相比差异无统计学意义（P〉0.05）。胃肠减压组和对照组的术后进食时间、住院时间和并发症差异均无统计学意义（P〉0.05）。211例患者按术后有无肠梗阻分为肠梗阻组（32例）和无肠梗阻组（179例）,两组进食时间分别为9.1和4.9 d,肠梗阻组进食时间明显长于无肠梗阻组（P〈0.01）,但两组在年龄、性别、手术时间、失血量和住院时间方面差异均无统计学意义（P〉0.05）。肠梗阻组有7例肺部感染（21.8%,7/32）,无肠梗阻组有3例肺部感染（1.7%,3/179）,肠梗阻组肺部感染明显高于无肠梗阻组（P〈0.01）。结论根治性膀胱切除术后不留置胃肠减压是安全有效的,且更有利于患者的恢复;围手术期的护理有待进一步改进,以减少术后并发症和缩短住院时间。

Evaluation of clinical necessity of gastrointestinal decompression after radical cystectomy and urinary diversion

Objective To evaluate the clinical necessity of gastrointestinal decompression after radical cystectomy. Methods We reviewed the records of 211 consecutive patients who underwent radical cystectomy in recent ten years.Patients were divided into two groups,with or without receiving gastrointestinal decompression before operation.We compared the two groups in the incidence of complications and clinical variables. Results 32 patients developed postoperative ileus in these 211 radical cystectomy patients（15.2%）.Ileus was observed in 4 patients in the gastrointestinal compression group and 28 patients in the control group（22.2% vs 14.5%,P〉0.05）.There were no signifcant differences in time to start a liquid diet,hospital stay and complications between the two groups（P〉0.05）.Patients were divided into two groups-those with ileus and those without ileus.The time to start a liquid diet was obvious longer in the ileus group than that the control group（9.1 vs 4.9 days,P〈0.01）.There were no differences in age,sex,operative time,blood loss and hospital stay between the two groups.The pulmonary infection rate was significantly higher in the ileus group than in the control group（21.8% vs 1.7%,P〈0.01）. Conclusions The recovery of patients who underwent radical cystectomy and urinary diversion will benefit from non-gastrointestinal decompression,and perioperative management should be improved in order to reduce morbidity and early hospital discharge.