根治性膀胱切除术围手术期并发症分析

目的探讨根治性膀胱切除术围手术期并发症的情况。方法回顾性分析211例行根治性膀胱切除患者围手术期并发症发生的情况，围手术期并发症定义为术中及术后30d内发生的并发症。结果211例患者中有72例（34.1％）发生一种或一种以上的并发症，其中肠梗阻32例（15.2％），是最常见的并发症；其次是伤口感染20例（9.5％）、肺部感染10例（4.7％）。围手术期再次手术16例（7.6％）。211例患者按年龄分为高龄组35例（≥70岁）和低龄组176例（〈70岁），两组的手术时间、并发症和住院时间相近，差异无统计学意义（P〉0.05）；按尿流改道方式分为可控组和非可控组（回肠膀胱），前者的手术时间和住院时间明显长于后者，差异有统计学意义（P〈0.01）。结论根治性膀胱切除仍有较高的并发症发生率，其中肠梗阻最常见。年龄不是该手术的禁忌证，尿流改道方式是影响手术时间和术后住院时间的重要因素。

A critical analysis of perioperative complications from radical cystectomy

Objective To evaluate perioperative complications of 211 patients undergone radical cystectomy. Methods The clinical data of 211 cases of radical cystectomy from January 1996 to December 2006 were reviewed retrospectively. Perioperative complications were defined as any adverse event within 30 d post-operation. Results A total of 72 patients（34.1%）developed at least one perioperative complication. The most frequent complications were subileus in 32（15. 2%）patients, wound infection in 20（9.5 %）, and pulmonary infection in 10 （4.7%）. The perioperative reoperation rate was in 16（7.6%）. The operative time and hospital stay were longer for patients who had undergone continent diversions or neobladder than those undergone ileal conduits（P〈0.01）. There were no significant difference in operative time, complications and hospital stay between the elderly patients（age≥70 years,n=35）and young patients（P〉0.05）. Conclusions It was suggested that patients undergone radical cystectomy have a certain high rate of perioperative complications. Elderly is not a contraindication for surgery. The approach of urinary diversion is an important factor that influences operative time and hospital stay.