Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Urology. 2010 Dec;76(6):1419-24. doi: 10.1016/j.urology.2010.02.053. Epub 2010 May 15.
To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus (POI). POI is a common complication after radical cystectomy and can result in a prolonged hospital stay and delayed recovery.
A retrospective cohort study design was used to analyze data from consecutive patients presenting to our institution for radical cystectomy with pelvic nodal dissection. POI was declared if patients were without evidence of bowel function beyond the anticipated discharge goal of 6 days. The association between several clinical features and the occurrence of POI was examined.
Of 283 patients, 43 (15.2%) developed POI. Of the 43 patients, 38 (88.4%) were given total parenteral nutrition for nutritional supplementation. No difference in the incidence of POI was observed between the sexes, previous abdominal operations, estimated blood loss, transfusion requirement, operative time, neoadjuvant chemotherapy, or previous radiotherapy. POI was observed in 11.3% of normal and overweight patients (body mass index [BMI] <30.0 kg/m(2)) compared with 25.6% of obese patients (BMI ≥30.0 kg/m(2); P = .005). On multivariate analysis adjusted for the influence of competing variables, increasing age (hazard ratio 1.09, 95% confidence interval 1.02-1.16, P = .008) and BMI (hazard ratio 1.09, 95% confidence interval 1.03-1.17, P = .007) were significantly associated with the presence of POI.
Our results showed that increasing age and BMI were significantly associated with the presence of POI in patients undergoing radical cystectomy for bladder cancer.
确定有助于识别发生术后麻痹性肠梗阻（POI）风险最大的患者的危险因素。POI 是根治性膀胱切除术后的常见并发症，可导致住院时间延长和恢复延迟。
采用回顾性队列研究设计，分析了连续就诊于我院行根治性膀胱切除术和盆腔淋巴结清扫术的患者数据。如果患者在预期的 6 天出院目标后仍无肠道功能迹象，则宣布发生 POI。检查了几种临床特征与 POI 发生之间的关联。
在 283 例患者中，有 43 例（15.2%）发生 POI。在这 43 例患者中，有 38 例（88.4%）接受了全肠外营养以补充营养。性别、既往腹部手术、估计失血量、输血需求、手术时间、新辅助化疗或既往放疗对 POI 的发生率无影响。在正常体重和超重患者（体重指数 [BMI] <30.0 kg/m2）中观察到 POI 的发生率为 11.3%，而在肥胖患者（BMI ≥30.0 kg/m2）中为 25.6%（P =.005）。在调整竞争变量影响的多变量分析中，年龄增长（风险比 1.09，95%置信区间 1.02-1.16，P =.008）和 BMI（风险比 1.09，95%置信区间 1.03-1.17，P =.007）与 POI 的存在显著相关。
我们的结果表明，年龄增长和 BMI 与膀胱癌患者接受根治性膀胱切除术时发生 POI 显著相关。
