根治性膀胱全切术围手术期并发症风险因素分析

目的探讨与根治性膀胱切除术围手术期并发症相关的手术风险因素。方法回顾性分析本院2006年11月至2009年10月行根治性膀胱切除术患者资料共128例。收集手术风险因素、评估合并症情况,将住院期间发生的并发症分为次要并发症和主要并发症,对相关手术风险因素进行分析。结果 128例患者中2例(1.56%)死亡,58例(45.31%)发生并发症,其中51例(39.84%)次要并发症,7例(5.47%)主要并发症。伤口裂开或不愈合(29例,22.66%)、感染(6例,20.31%)、术后肠梗阻(22例,17.19%)为最常见的并发症。并发症发生的风险因素有:年龄≥65岁(P<0.001,OR=1.067)、术中输血量≥600mL(P=0.023,OR=1.001)、m-ACCI评分≥4wv(P<0.001,OR=1.583)、ASA评分≥Ⅲ级(P=0.003,OR=2.411)、有膀胱部分切除手术史(P=0.025,OR=2.444)、术中最高心率>120次/min(P<0.001,OR=11.861)。结论伤口愈合不佳、术后感染及术后肠梗阻是根治性膀胱全切术常见并发症。年龄、术中输血量、m-ACCI评分、ASA评分、膀胱部分切除手术史和术中最高心率是发生并发症的风险因素。

Critical Analysis on Risk Factors of Postoperative In-hospital Complications in Radical Cystectomy of Bladder Cancer

Objective To evaluate the risk factors associated with the in-hospital complications of radical cystectomy.Methods The records of 128consecutive patients who underwent radical cystectomy from November 2006to October 2009were reviewed.Preoperative,intraoperative risk variables were defined based on POSSUM score and APACHE Ⅱscore.ASA score and m-ACCI score were used to evaluate the co-mobidities.All variables were analyzed to evaluate the risk factors associated with in-hospital complications of radical cystectomy.Results In the 128patients undergoing radical cystectomy,58patients(45.31%) had complications,with 51(39.84%) minor complicatons and 7(5.47%) major complications.Wound dehiscence or unhealing(22.66%),infection(20.31%) and ileus(17.19%) were the most common complications.The risk factors related to the in-hospital complications of radical cystectomy are age≥65yr.(P<0.001,OR=1.067),volume of intraoperative blood transfusion≥600 mL(P=0.023,OR=1.001),m-ACCI score(P<0.001,OR=1.583),ASA score≥Ⅲ(P=0.003,OR=2.411),partial cystectomy history(P=0.025OR=2.444),intraoperative heart rate>120beats / min(P<0.001,OR= 11.861).Conclusions Wound complication,postoperative infection and ileus are the most common complications of radical cystectomy.Age,volume of intraoperative blood transfusion,m-ACCI score,ASA score,partial cystectomy history and intraoperative heart rate are significant risk factors.