根治性膀胱切除术后早期并发症及危险因素分析

目的:探讨根治性膀胱切除术(RC)后早期并发症(术后90 d内)及其相关的危险因素.方法:收集我院泌尿外科2013年1月至2016年1月期间共185例因膀胱癌行根治性膀胱切除术(RC)的临床资料,术后90天内对患者随访,并应用X2检验和Logistic回归分析术后常见早期并发症的危险因素.结果:术后90天内185位患者中有74位(40.0％)出现了不同的早期并发症,常见并发症依次为肠梗阻、泌尿系感染、切口方面并发症.在回归分析中发现年龄(≥65岁)、肥胖(BMI≥25 kg/m2)、术中输血、手术方式、手术时间、糖尿病是发生RC术后早期并发症的危险因素.结论:根治性膀胱切除术术后早期并发症发生率较高,其中肠梗阻、泌尿系感染、切口方面并发症较常见,正确的围手术期处理及充足的术前准备是降低膀胱癌根治术术后早期并发症的关键.     

95例非计划再次手术原因分析与对策

[目的]探讨非计划再次手术的原因及影响因素.[方法]提取2011～2015年医疗统计系统资料,对10个手术科室发生的非计划再次手术病例进行分析.[结果] 2011～2015年全院10个手术科室共开展手术60 005例,发生非计划再次手术95例,发生率0.15％.术后出血、吻合口瘘、副损伤是发生非计划再次手术的主要原因.[结论]非计划再次手术与患者病情、病种及术者专业水平、操作技术有关.因此,建立可操作的动态管理和质控制度及措施,降低非计划再次手术的发生势在必行.     

再次手术治疗食管癌和贲门癌切除术后近期并发症

目的探讨再次手术在食管癌和贲门癌切除术后近期并发症治疗中的地位及其适应症。方法分析本院2914例食管癌和贲门癌切除术后再次手术治疗的并发症23例。包括术后大出血8例，乳糜胸6例，胃出口梗阻3例，肠梗阻3例，膈下脓肿2例，及腹部切口裂开1例。结果再次手术治疗并发症占总并发症的6.9%(23/331)。再次手术治愈率91.3%(21/23)，死亡率为8.7%(2/23)。结论再次手术在食管癌和贲门癌切除术后近期并发症治疗中占有重要地位，其适应症主要依据并发症类型及病情轻重确定。术后大出血、乳糜胸、胃肠梗阻等是再次手术治疗的常见并发症。     

腮腺肿瘤再次手术的临床原因分析

腮腺肿瘤患者再次行手术的病例 ,近年来有所增加。我们收集了 2 0 0 0年 1月至 2 0 0 3年 1月间 ,治疗的此类病员 2 1例 ,对其再次手术的临床原因作如下分析。1　临床资料本组 2 1例 ,男 14例 ,女 7例。年龄在 7岁到 72岁之间。均因腮腺肿瘤曾行手术治疗。 2 1例中 ,再次手术与前次手术间隔时间 :7年 4例 ,4年 3例 ,3年 8例 ,1年 3例 ,1个月内的 2例 ,1周内的 1例。其中 :1例 2年内行 3次手术 ;1例 1年内行 2次手术 ;1例 1月内行 2次手术 ;1例 1周内行 2次手术。麻醉 :4例采用全麻 ,其余均采用局麻。切口 :取“S”形切口 5例 ,其余均系耳垂…     

高龄膀胱癌患者全膀胱切除术的并发症及生存分析

摘 要：［目的］ 探讨高龄膀胱癌患者接受全膀胱切除术的临床病理特点,围手术期并发症和疗效。［方法］ 回顾性分析2012年1月至2016年12月间年龄≥75岁,接受全膀胱切除术的高龄患者,收集患者的临床病理信息,统计学分析患者围手术期并发症及生存情况。［结果］ 57例年龄≥75岁,在我院接受全膀胱切除术的高龄患者,尿流改道方式分别为回肠膀胱术13例和输尿管皮肤造口术44例,无一例患者在围手术期间死亡。22例（38.6%）患者出现围手术期并发症。常见的并发症包括感染、肠梗阻、肾盂输尿管积水等。无复发生存时间（RFS）为11.4个月,中位总生存时间为15.8个月。回肠膀胱术和输尿管皮肤造口术两种尿流改道术式的RFS无统计学差异。［结论］ 肌层浸润或高危复发的高龄膀胱癌患者,全膀胱切除术并发症发生率可以接受。在合适的患者身上,尿流改道应尽可能选用回肠膀胱术。     

甲状腺癌局部切除后再次手术23例临床分析

 目的 探讨甲状腺癌行局部切除后再次手术的意义、手术时机及手术方式。方法 回顾性分析我科1995年9月至2002年6月收治的23例甲状腺癌再次手术的临床资料。结果 再次手术甲状腺及周围组织残癌率为21.7 %。结论 甲状腺癌行局部切除后再次手术有必要，对不明性质的甲状腺结节行患侧腺叶切除加峡部切除这一术式，以降低再次手术率。     

膀胱癌膀胱全切除术后早期并发症的相关影响因素研究

目的探讨膀胱癌膀胱全切除术后早期并发症发生的相关因素。方法收集200例膀胱癌患者的手术资料和术后3个月的随访资料,包括手术时间、术中出血量、术中输血量、术后住院时间等。根据改良的Clavien分级系统对膀胱癌患者术后早期并发症进行分级。分析膀胱癌患者术后早期并发症发生的影响因素。结果200例膀胱癌患者中,124例患者术后出现早期并发症。有并发症膀胱癌患者和无并发症膀胱癌患者的年龄、糖尿病史、美国麻醉医师协会(ASA)分级、入院症状、尿流改道方式、术后住院时间比较,差异均有统计学意义(P<0.05);多因素分析结果显示:年龄、糖尿病史、入院症状、术后住院时间、ASA分级为膀胱癌患者术后早期并发症发生的独立影响因素。结论膀胱癌患者膀胱全切除术后早期并发症的发生率较高,年龄较大、有糖尿病史、ASA分级高、有入院症状、术后住院时间长的膀胱癌患者术后早期并发症的发生风险较高,因此要加强对该部分人群的重点关注和预防控制。     

腹腔镜下根治性全膀胱切除术应用进展

膀胱癌是泌尿系统最常见的恶性肿瘤,全膀胱切除术是治疗浸润性膀胱癌最有效的方法。1992年Parra等报道了首例腹腔镜全膀胱切除术,2000年Gill等报道2例腹腔镜根治性膀胱切除加回肠通道术,2002年报道首例腹腔镜根治性膀胱切除加原位回肠膀胱术。国内外泌尿外科医生们在腹腔镜下根治性膀胱切除（laparoscopicradicalcystectomy,LRC）及尿路重建方面进行了积极的探索。现就腹腔镜下根治性全膀胱切除术的应用进展作一综述。     

腹腔镜根治性膀胱切除术后淋巴漏发生因素分析及预防措施

目的:探讨腹腔镜根治性膀胱切除术后淋巴漏原因及相关危险因素、预防措施。方法:收集2015年01月至2020年12月在我院泌尿外科行腹腔镜根治性膀胱切除及盆腔淋巴结清扫术患者的年龄、BMI、术前术后血红蛋白、术前术后白蛋白、清扫淋巴结数、阳性淋巴结数、术中是否Hem-o-lock夹闭淋巴管资料,采用t检验和Logistic回归分析淋巴漏发生因素。结果:45例患者中,淋巴漏组18例,非淋巴漏组27例,t检验显示阳性淋巴结数与术后淋巴漏发生密切相关,Logistic回归分析显示是否使用Hem-o-lock夹闭淋巴管及阳性淋巴结数与术后淋巴漏发生密切相关。经营养支持、补充白蛋白、抗感染、保持引流管通畅,术后10~20天淋巴漏均治愈。结论:阳性淋巴结数及清扫术后是否夹闭淋巴管是淋巴漏发生的高危因素,术后贫血严重患者更易发生淋巴漏。加强营养,纠正贫血,补充白蛋白,术中精准操作,使用Hem-o-lock确切结扎可减少淋巴漏的发生。     

腹腔镜与开放手术开展根治性膀胱切除术的Meta分析

目的:评价腹腔镜(LRC)和开放手术(ORC)进行根治性膀胱切除术的近期效果的差异.方法:搜索中英文数据库Pubmed、EMBASE、Cochrane library、Sciencedirect、CNKI、Sinomed等,检索和筛选已发表的有关腹腔镜与开放手术进行根治性膀胱切除术的随机对照试验(RCT)以及非随机对照试验(NRCT),手术方式均为根治性全膀胱切除.对纳入研究进行质量评价、筛查,提取相关数据,STATA 11.0软件进行Meta分析.结果:纳入10篇文献,共678名患者.其中4篇中文文献,6篇外文文献.由于涉及伦理原因,均为回顾性NRCT文献.各研究间年龄、性别、BMI等基础资料未见统计学差异.Meta分析结果提示:LRC相比ORC,手术时间更长(P ＜0.0001),术中出血量少(P ＜0.0001),切缘阳性率低(P =0.014),淋巴结清扫数多(P=0.04),肠道恢复时间短(P＜0.0001),住院时间短(P ＜0.0001),并发症发生率低(P =0.007),新膀胱容量无差异(P =0.704).结论:在根治性全膀胱术的选择中,除手术时间外,LRC各项指标均优于ORC.鉴于临床RCT实验文献较少,仍需多中心、大样本、前瞻性的RCT实验,进行长期随访.     

Long-term Health-related Quality of Life (HRQOL) After Radical Cystectomy and Urinary Diversion - A Propensity Score-matched Analysis

IntroductionRadical cystectomy (RC) and urinary diversion by ileal conduit (IC) or ileal orthotopic neobladder (ONB) is the standard-of-care for surgical treatment of muscle-invasive bladder cancer. Yet, it is unclear how urinary diversion affects the patient's health-related quality of life (HRQOL) in the longer-term.MethodsHRQOL was assessed preoperatively, 3mo postoperatively and then annually until a maximum follow-up of 48 months using the validated EORTC QLQ-C30- as well as the bladder cancer-specific FACT-BL- and QLQ-BLM30-questionnaires. A propensity-score matching for the variables “age,” “ASA-classification,” “cardiovascular co-morbidity,” “sex” as well as “tumor stage,” and “preoperative physical functioning score” was performed. Hypothetical predictors for decreased general HRQOL were analyzed using multivariable logistic regression models.ResultsAfter propensity-score matching, 246 patients were analyzed. HRQOL assessment revealed significant differences regarding preoperative QLQ-C30 symptoms which diminished during the postoperative time course. Similarly, we did not find significant differences based on bladder cancer-specific FACT-BL and QLQ-BLM HRQOL assessment including body image (48 months: 29.6.4 [IC] vs. 40.7 [ONB]; P = .733). Regarding general HRQOL, we found increased global health status scores for ONB throughout the whole observational period without reaching statistical significance (48 months: 55.0 [IC] vs. 70.1 [ONB]; P = .079). In multivariate analysis, cardiovascular comorbidity was an independent predictor of impaired HRQOL 24 months (HR 2.20; CI95% 1.02-5.72, P = .044) and 36 months (HR 6.84; CI95% 1.61-29.14, P = .009) postoperatively.ConclusionWe did not observe significant differences in bladder-specific as well as generic HRQOL in the longer-term and consequently, the type of urinary diversion was not an independent predictor of good general HRQOL in a follow-up period of 4 years.     

全膀胱切除尿流改道方法的再评

３１例膀胱癌行膀胱全切除后进行６例乙状结肠代膀胱、１８例输尿管乙状结肠吻合及７例输尿管皮肤造口术，随访４～１０年，疗效满意。作者认为上述尿流改道的方法相对简单、安全、有效，而且并发症少，可供临床推广应用。     

Risk of Readmission After Uncomplicated Hospitalization After Radical Cystectomy

Background

Enhanced recovery pathways after radical cystectomy attempt to decrease length of hospitalization, but might increase risk of readmission after discharge. We evaluated the relationship between length of stay and readmission after uncomplicated hospitalization for bladder cancer patients treated with radical cystectomy.

Evaluation of Cause of Death After Radical Cystectomy for Patients With Bladder Cancer: The Impact of Age at the Time of Surgery

IntroductionPatients with bladder cancer treated with radical cystectomy (RC) have heterogeneous results in term of cancer-specific (CSM) and other cause mortality (OCM). Our aim is to assess the impact of age on cause of death after RC.Patients and MethodsWe retrospectively analyzed the data of 1222 patients treated with RC and bilateral pelvic lymph node dissection owing to nonmetastatic bladder cancer between 1990 and 2013. Patients were stratified according to age (< 59 vs. 60-69 vs. 70-79 vs. ≥ 80 years), tumor T stage at RC (pT0-T2 vs. pT3-T4), and tumor N stage at RC (pN+ vs. pN0). Competing-risks survival analyses were used to estimate CSM and OCM rates.ResultsWith a median follow up of 6 years, 92 (7.5%) and 385 (31.5%) OCM and CSM were recorded. The 5-year CSM and OCM rates were 40% and 8.8%, respectively. After stratification according to disease stage and patient age, CSM emerged as the main cause of mortality in all patient subgroups. The 5-year OCM was 4.6%, 4.8%, 11%, and 32% for patients aged < 60 years versus 60 to 69 years versus 70 to 79 years versus ≥ 80 years, respectively. The 5-years CSM was 34%, 45%, 35%, and 56% for patients aged < 60 years versus 60 to 69 years versus 70 to 79 years versus ≥ 80 years, respectively. Similar findings were observed stratifying the population according to pathologic T and N stage.ConclusionCSM is the preponderant cause of death for all the patients, regardless of age or stage. In this regard, RC also seems to be a reasonable approach for octogenarians.     

分化型甲状腺癌再手术42例分析

１９８５年１月至１９９５年１０月，４２例分化型甲状腺癌施行了再手术治疗。其中男性７例，女性３５例。再手术原因：原发癌灶残留；术后复发；颈淋巴结转移灶残留；对侧甲状腺及对侧颈淋巴结出现癌灶。再手术方式：原发癌灶局切者应再次切除残叶及峡部；对肿瘤侵出包膜者，作者认为应放宽预防性淋巴结清扫术的指征，有淋巴结转移者施行传统性或功能性颈淋巴结清扫术；对侧腺叶出现癌灶或对侧出现颈淋巴结转移者，应做对侧甲状腺癌的根治手术。     

Adverse Pathology After Neoadjuvant Chemotherapy and Radical Cystectomy: The Role of Adjuvant Chemotherapy

Background

The current guidelines do not recommend adjuvant chemotherapy (AC) for patients with adverse pathologic findings after neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) for bladder cancer. We sought to evaluate the association of AC with overall survival (OS) in these patients.

根治性放疗与根治性手术治疗肌层浸润性膀胱癌的Meta分析

[目的]系统评价根治性放疗与根治性手术治疗膀胱癌临床效果.[方法]应用END-NOTE软件全面检索Pubmed(1973～2013年)数据库,对符合纳入标准的临床对照试验,采用RevMan 4.3软件进行Meta分析.对于无对照临床研究资料,采用同质合并分析.[结果]共纳入6个临床对照试验,共1 264例患者,Meta分析结果显示,根治性放疗与根治性手术切除治疗膀胱癌患者的5年生存率无统计学差异(P=0.36),合并比值比(OR)为1.10 (95％CI:0.86～1.40).18篇无对照临床研究共纳入根治性放疗治疗膀胱癌患者1 749例,多数文献采用全膀胱放疗40～60Gy,联合以顺铂为基础的化疗方案,完全反应率达到65％以上,平均5年总生存率在50％以上,最低为37％,最高可达82％.[结论]根治性放疗不会降低膀胱癌患者生存率,且能维持正常膀胱功能,提高了患者生存质量.     

膀胱全切后改良Indiana膀胱转流术

目的 探讨—种新式改良Indiana新膀胱术的适应证、手术方法并对疗效进行评估。方法 对5例膀胱癌患者施行全膀胱切除术加改良Indiana新膀胱术。结果 5例患者均获得满意的疗效，自行导尿顺利。随访6-30个月，均尿控满意，排尿次数5-6次/昼，1-3次/夜。其中4例行造影，新膀胱呈球形，容量400-500毫升，无输尿管尿液返流。结论 改良Indiana膀胀术具有操作容易，贮尿囊低压容量大，抗返流机制可靠，尿控满意，并发症少的优点，值得在临床推广。     

Laparoscopic Versus Open Radical Cystectomy for Patients Older than 75 Years: a Single-Center Comparative Analysis

Background: To explore the safety, efficacy, and oncological outcome of 3-port laparoscopic radical cystectomy(LRC) compared to open radical cystectomy (ORC) in patients older than 75 years. Materials and Methods:From June 2010 to July 2014, we analyzed 16 radical cystectomies in patients older than 75 years (LRC group=8;ORC group=8). Demographic parameters, operative variables, and perioperative outcome in the 2 groups wereretrospectively collected, analyzed, and compared. Results: Patients in both groups had comparable preoperativecharacteristics. A significantly longer operating time (476 vs. 303 min, P=0.0002) and less estimated blood loss(627 vs. 2,106 mL, P=0.021) were observed in the LRC group compared to the ORC group. Infection and ileuswere the most common early complications after surgery. Patients who underwent ORC suffered from morepostoperative infection (22.2% vs. 0.0%, P=0.054) and ileus (25.0% vs. 12.5%, P=0.521) than the LRC group, butthe difference was not significant. Conclusions: Judging from this initial trial, 3-port LRC can be safely carriedout in elderly patients. We suggest 3-port LRC as the primary intervention to treat muscle-invasive or high-risknonmuscle-invasive bladder cancer in elderly patients with an otherwise relatively long life expectancy.     

Early Discharge After Radical Nephrectomy: An Analysis of Complications and Readmissions

Introduction

Length of stay (LOS) is increasingly being viewed as a quality metric, and efforts to reduce LOS are present across most surgical subspecialties. However, data on whether reducing LOS is safe in patients who undergo radical nephrectomy (RN) are lacking. The purpose of this study was to assess whether early discharge after RN affects readmission rates and postdischarge complications using a national cohort of patients.