Department of Urology, University of Bern, Bern, Switzerland.
Eur Urol. 2011 Feb;59(2):204-10. doi: 10.1016/j.eururo.2010.10.030. Epub 2010 Nov 5.
Prolonged postoperative pain and delayed intestinal transit are frequent problems following extended pelvic lymph-node dissection (PLND) and cystectomy.
To evaluate the impact of bilateral readaptation of the dorsolateral peritoneal layer on postoperative pain, gastrointestinal recovery, and complications following extended PLND and cystectomy.
DESIGN, SETTING, AND PARTICIPANTS: Randomized, single-blinded, single-center study of 200 consecutive cystectomy patients.
In group A (n=100), lateral peritoneal flaps ventral to the external iliac vessels were bilaterally rotated over the iliac vessels down to the distal obturator fossa and medially fixed to the pararectal peritoneal layer following extended PLND and cystectomy. In group B (n=100), the peritoneal layer was not readapted.
Pain according to the visual analog scale (VAS), amount of peridural anesthetics needed, and gastrointestinal activity were assessed on postoperative days 1, 3, and 7. Complications occurring within 30 d following surgery were documented.
Readaptation of the dorsolateral peritoneal layer resulted in a significant decrease in pain (p<0.01) with concurrent significantly reduced need for peridural anesthetics (p<0.01). Flatulence and first passage of stool as signs of intestinal transit were noted earlier in group A than in group B. Gastrostomy tube and peridural catheter could be removed 1 d earlier in group A than in group B (postoperative days 7 vs 8 and 6 vs 7, respectively). Group A (30%) had fewer complications than group B (56%; p<0.001).
Readaptation of the dorsolateral peritoneal layer after extended PLND and cystectomy resulted in significantly less postoperative pain, earlier recovery of bowel function, and fewer complications in the early postoperative period.
广泛盆腔淋巴结清扫术（PLND）和膀胱切除术术后常出现长期疼痛和延迟肠道蠕动。
评估双侧背外侧腹膜层再适应对广泛 PLND 和膀胱切除术后术后疼痛、胃肠恢复和并发症的影响。
设计、设置和参与者：200 例连续膀胱切除术患者的随机、单盲、单中心研究。
在 A 组（n=100）中，在广泛 PLND 和膀胱切除术后，将腹侧外髂血管的外侧腹膜瓣双侧旋转至髂血管下方至远端闭孔窝，并向内侧固定至直肠旁腹膜层。在 B 组（n=100）中，腹膜层未进行再适应。
术后第 1、3 和 7 天，根据视觉模拟量表（VAS）评估疼痛、硬膜外麻醉剂的用量和胃肠活动。记录术后 30 天内发生的并发症。
背外侧腹膜层的再适应导致疼痛明显减轻（p<0.01），同时硬膜外麻醉剂的需求明显减少（p<0.01）。A 组更早出现肠转运的标志，如肠鸣音和首次排便。与 B 组相比，A 组更早拔除胃造口管和硬膜外导管（术后第 7 天 vs 第 8 天和第 6 天 vs 第 7 天）。A 组（30%）并发症少于 B 组（56%；p<0.001）。
广泛 PLND 和膀胱切除术后背外侧腹膜层再适应可显著减轻术后疼痛，更早恢复肠道功能，并减少术后早期并发症。
