de Vries R R, Kauer P, van Tinteren H, van der Poel H G, Bex A, Meinhardt W, van Haarst E P, Horenblas S
Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Urol Int. 2012;88(4):383-9. doi: 10.1159/000336155. Epub 2012 Mar 14.
To compare the outcome of two perioperative protocols with respect to postoperative management of cystectomy patients.
Between June 2007 and November 2008, 85 consecutive patients with bladder cancer were treated with cystectomy and urinary diversion. Patients were operated in two hospitals by four urologic surgeons. In protocol A, patients were enterally fed via a postpyloric tube while the nasogastric tube (NGT) was removed directly after cystectomy and selective decontamination of the digestive tract was given until normal oral intake. In protocol B, postcystectomy management consisted of total parenteral nutrition by a central venous line and NGT removal after 24 h. Hospital stay and complications were compared between the two hospitals.
More than half of all patients (52%) developed one or more complications within 30 days after surgery, 37% in protocol A and 71% in protocol B (p = 0.002). Higher ASA score and protocol type were the only factors significantly associated with early complications in both uni- and multivariate analyses. Length of stay was significantly shorter with protocol A as compared to protocol B, 13 days versus 19 days (p = 0.006).
Cystectomy and urinary diversion is a procedure with considerable risk of complications. Enteral nutrition might be advantageous as compared to parenteral nutrition, showing fewer complications and shorter hospital stay. A high ASA score is associated with more early complications. Selective bowel decontamination may have an additional role in preventing infectious complications after cystectomy.
比较两种围手术期方案在膀胱切除术患者术后管理方面的效果。
2007年6月至2008年11月期间，85例连续性膀胱癌患者接受了膀胱切除术及尿流改道术。患者在两家医院由四位泌尿外科医生进行手术。在方案A中，患者通过幽门后管进行肠内喂养，膀胱切除术后直接拔除鼻胃管（NGT），并给予消化道选择性去污，直至正常经口摄入。在方案B中，膀胱切除术后管理包括通过中心静脉导管进行全胃肠外营养，并在24小时后拔除NGT。比较两家医院的住院时间和并发症情况。
超过一半的患者（52%）在术后30天内出现一种或多种并发症，方案A组为37%，方案B组为71%（p = 0.002）。在单因素和多因素分析中，较高的美国麻醉医师协会（ASA）评分和方案类型是与早期并发症显著相关的唯一因素。与方案B相比，方案A的住院时间显著缩短，分别为13天和19天（p = 0.006）。
膀胱切除术及尿流改道术是一种并发症风险较高的手术。与胃肠外营养相比，肠内营养可能具有优势，并发症更少，住院时间更短。较高的ASA评分与更多的早期并发症相关。选择性肠道去污可能在预防膀胱切除术后的感染性并发症方面具有额外作用。
