Pruthi Raj S, Chun Judy, Richman Marc
Division of Urologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
Urology. 2003 Oct;62(4):661-5; discussion 665-6. doi: 10.1016/s0090-4295(03)00651-4.
To outline our current perioperative treatment of patients undergoing radical cystectomy and urinary diversion, which uses advancements in perioperative care to allow for early institution of an oral diet and early hospital discharge, and thereby overall improvement in patient recovery and outcome after this procedure.
Forty consecutive patients underwent radical cystectomy and urinary diversion with curative intent from 2001 to 2002. A care plan was followed for all patients and included improvements in preoperative, intraoperative, and postoperative care. The preoperative care included limited outpatient bowel preparation with sodium phosphate solution and patient education. Operative modifications included reduced incision length, initial preperitoneal dissection, and the use of internal surgical stapling devices. The postoperative care included the use of prokinetic agents, early nasogastric tube removal, the use of non-narcotic analgesics, and early institution of an oral diet. The outcomes with regard to time to institution of an oral diet, tolerance of a regular diet, and hospital discharge were assessed.
The mean surgical time was 3.9 hours, and the mean estimated blood loss was 573 mL. The mean time to the institution of a clear liquid diet was 2.0 days and to a regular diet was 4.2 days. The mean time to hospital discharge was 5.1 days. No statistically significant differences were found in the time to resumption of a regular diet or to discharge between patients undergoing ileal conduits versus orthotopic ileal neobladders. Only 1 patient had any gastrointestinal dysfunction (ileus), and this patient was discharged on postoperative 7. No patient had any delayed complications involving problems with diet intolerance or other gastrointestinal dysfunction. The results of the current series were compared with those of historical controls.
Advancements in preoperative, intraoperative, and postoperative management have together been successfully used in our patient population to reduce morbidity and improve recovery with regard to the early institution of an oral diet and early hospital discharge.
概述我们目前对接受根治性膀胱切除术和尿流改道患者的围手术期治疗，该治疗利用围手术期护理的进展，实现早期经口进食和早期出院，从而全面改善该手术后患者的恢复情况和预后。
2001年至2002年，40例连续患者接受了根治性膀胱切除术和尿流改道，目的是治愈疾病。所有患者均遵循一项护理计划，该计划包括术前、术中和术后护理的改进。术前护理包括使用磷酸钠溶液进行有限的门诊肠道准备和患者教育。手术改进包括缩短切口长度、初始腹膜前剥离以及使用内部手术吻合器。术后护理包括使用促动力药物、早期拔除鼻胃管、使用非麻醉性镇痛药以及早期经口进食。评估经口进食时间、常规饮食耐受性和出院情况等结果。
平均手术时间为3.9小时，平均估计失血量为573毫升。开始进食清流食的平均时间为2.0天，开始进食常规饮食的平均时间为4.2天。平均出院时间为5.1天。在接受回肠导管术与原位回肠新膀胱术的患者之间，恢复常规饮食或出院的时间没有统计学上的显著差异。只有1例患者出现任何胃肠道功能障碍（肠梗阻），该患者于术后第7天出院。没有患者出现任何与饮食不耐受或其他胃肠道功能障碍相关的延迟并发症。将本系列结果与历史对照结果进行了比较。
术前、术中和术后管理的进展已成功应用于我们的患者群体，以降低发病率，并在早期经口进食和早期出院方面改善恢复情况。
