Section of Urology, The University of Chicago Medical Center, Chicago, Illinois 60637, USA.
Curr Opin Urol. 2013 Sep;23(5):456-65. doi: 10.1097/MOU.0b013e32836392bb.
To define the incidence of perioperative morbidity following contemporary radical cystectomy and identify preoperative, intraoperative, and postoperative strategies to reduce complications.
When complications are methodically and systematically recorded, 64% of patients will sustain a complication within 90 days of radical cystectomy. Various preoperative, postoperative, and intraoperative strategies have been identified to reduce morbidity. Prior to surgery, patients should have reversible medical conditions treated, mechanical bowel preparation can be omitted if using small bowel for reconstruction, venous thromboembolism and antimicrobial infection prophylaxis should be initiated, nutrition should be optimized, and patient education should be provided. During surgery, complications can be attenuated by utilizing meticulous surgical technique, minimizing blood loss, fluid management can be guided by transesophageal cardiovascular Doppler, and lower extremity repositioning should be performed as soon as feasible. After surgery, early mobilization, incentive spirometry, early nasogastric tube removal, alvimopan usage, and judicious jejunostomy tube feeding, or total parenteral nutrition usage may reduce morbidity.
Morbidity is common following radical cystectomy, but careful attention to preoperative, intraoperative, and postoperative details can help reduce this risk.
定义当代根治性膀胱切除术围手术期发病率，并确定术前、术中和术后的策略以减少并发症。
当并发症被系统地记录时，64%的患者在根治性膀胱切除术后 90 天内会发生并发症。已经确定了各种术前、术后和术中策略来降低发病率。手术前，应治疗可逆转的医学状况，如果使用小肠进行重建，可以省略机械性肠道准备，应开始静脉血栓栓塞和抗菌感染预防，应优化营养，并提供患者教育。在手术过程中，可以通过使用精细的手术技术、最大限度地减少失血、通过经食管心血管多普勒引导液体管理以及尽快重新定位下肢来减轻并发症。手术后，早期活动、激励性肺活量计、早期鼻胃管去除、阿立哌唑的使用、合理的空肠造口喂养或全胃肠外营养的使用可能会降低发病率。
根治性膀胱切除术后发病率较高，但仔细注意术前、术中和术后的细节可以帮助降低这种风险。
