根治性膀胱切除术后早期再次手术原因分析

目的 探讨根治性膀胱切除术后早期再次手术的原因.方法 回顾性分析1996年1月至2007年12月根治性膀胱切除术227例,其中术后早期(30 d内)再次手术患者17例(7.5%),男性14例,女性3例,平均年龄56岁.肠道相关的并发症6例,输尿管代膀胱瘘合并阴道瘘1例,切口感染6例,切口裂开4例.结果 机械性肠梗阻2例,行小肠部分切除端端吻合术;早期粘连性肠梗阻1例,行肠粘连松解术;回肠吻合口瘘合并回肠新膀胱尿瘘1例,行回肠部分切除再吻合和回肠新膀胱修补术;乙状结肠吻合口瘘1例,行结肠造瘘术后出现小肠瘘经6次手术治愈;直肠瘘合并尿瘘1例,行结肠造口和输尿管代膀胱再吻合术;输尿管代膀胱吻合口瘘并阴道尿瘘1例,经充分引流后无效,行输尿管代膀胱再吻合术;伤口感染6例、伤口裂开4例,均经二次清创缝合治愈.失访2例,15例随访1个月～10 a,平均42个月.术后肿瘤转移死亡2例,肾功能恶化需长期血液透析1例,余12例病情稳定,生活质量满意.结论 根治性膀胱切除术后早期(30 d内)易出现并发症需再次手术,围手术期及时再次手术可减轻患者痛苦和改善生活质量.

The Analysis of Early Re-operation After Radical Cystectomy and Urinary Diversion

Objective To assess the cause of re-operation after radical cystectomy and urinary diversion.Methods The clinical data of 227 cases of radical cystectomy from January 1996 to December 2007 were reviewed retrospectively.Seventeen patients required a second abdominal procedure(7.5%) within 30-day of radical cystectomy.There were 14 male patients and 3 female patients.The mean age was 56 years old.Six patients with intestinal complications,1 patient with urine fistula,6 patients with wound infections,4 patients with wound dehiscences were observed.Results Two patients with obstructive ileus required partial resection and end-to-end anastomosis,1 patient with adhesive ileus needed enterolysis,1 patient with ileal anastomotic fistula and ileal neobladder urinary fistula was performed by partial resection and end-to-end anastomosis and neoplasty,1 patient with fistula of sigmoid colon required colostomy and was cured after six operations,1 patient with rectal fistula needed colostomy and reanastomosis of ureter,1 patient with stomal leakage and vagina leakage was performed by reanastomosis of ureter and ilea conduit,6 patients with wound infections and 4 patients with wound dehiscences required debridement and were cured.Fifteen patients were followed with an average of 42 months and 2 patients were lost.Two patients died from cancer,1 patient need long-term dialysis because of renal failure,and 12 patients had a good quality of life without complications.Conclusion Radical cystectomy is associated with early complications within 30-day of operation,and appropriate re-exploration promptly may improve the efficacy of the operation and the quality of patients.