根治性膀胱切除术采用加速康复方案后的胃肠道并发症。
Gastrointestinal Complications Following Radical Cystectomy Using Enhanced Recovery Protocol.
机构信息
USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Urology Department, Oregon Health & Science University, Portland, OR, USA.
出版信息
Eur Urol Focus. 2018 Dec;4(6):889-894. doi: 10.1016/j.euf.2017.04.003. Epub 2017 Apr 25.
BACKGROUND
The development of enhanced recovery after surgery (ERAS) protocols for patients undergoing radical cystectomy (RC) represents a significant advance in perioperative care.
OBJECTIVE
To evaluate gastrointestinal (GI) complications following RC and urinary diversion (UD) using our institutional ERAS protocol.
DESIGN, SETTING, AND PARTICIPANTS: We identified 377 consecutive cases of open RC and UD for which our ERAS protocol was used from May 2012 to December 2015. Exclusion criteria were consent refusal; non-bladder primary disease; palliative, salvage, or additional surgery; and prolonged postoperative intubation. A matched cohort of 144 patients for whom a traditional postoperative protocol (pre-ERAS) was used between 2003 and 2012 was selected for comparison.
RESULTS AND LIMITATIONS
A total of 292 ERAS patients with median age of 70 yr were included in the study, 65% of whom received an orthotopic neobladder. The median time to first flatus and bowel movement was 2 d. The median length of stay was 4 d. GI complications occurred in 45 patients (15.4%) during the first 30 d following RC, 93% of which were of minor grade. The most common GI complication was postoperative ileus (POI) in 34 cases (11.6%). Some 22 patients (7.5%) required a nasogastric tube, and parenteral nutrition was required in three patients. The rate of 30-d GI complications was significantly lower in the ERAS cohort than in the control group (13% vs 27%; p=0.003), as was the rate of POI (7% vs 23%; p<0.001). This effect was independent of other variables (hazard ratio 0.38, 95% confidence interval 0.18-0.82; p=0.01).
CONCLUSIONS
Our institutional ERAS protocol for RC is associated with significantly improved perioperative GI recovery and lower rates of GI complications. This protocol can be tested in multi-institutional studies to reduce GI morbidity associated with RC.
PATIENT SUMMARY
In this study, we showed that an enhanced recovery protocol for patients undergoing radical cystectomy for bladder cancer was associated with a significantly shorter length of hospital stay and lower rates of gastrointestinal complications, especially postoperative ileus.
背景
根治性膀胱切除术（RC）患者术后加速康复（ERAS）方案的制定是围手术期护理的重大进展。
目的
使用我们机构的 ERAS 方案评估 RC 和尿流改道术（UD）后的胃肠道（GI）并发症。
设计、地点和参与者：我们确定了 2012 年 5 月至 2015 年 12 月期间，我们机构的 377 例连续接受 RC 和 UD 的患者，他们使用了我们的 ERAS 方案。排除标准为拒绝同意、非膀胱癌原发疾病、姑息性、挽救性或附加手术、以及术后长时间插管。选择了 2003 年至 2012 年期间接受传统术后方案（ERAS 前）的 144 例患者作为匹配队列进行比较。
结果和局限性
共有 292 例 ERAS 患者入组，中位年龄为 70 岁，其中 65%接受了原位新膀胱。首次排气和排便的中位时间为 2 天。中位住院时间为 4 天。RC 后 30 天内，共有 45 例（15.4%）患者发生胃肠道并发症，其中 93%为轻度。最常见的胃肠道并发症是术后肠梗阻（POI），共 34 例（11.6%）。22 例（7.5%）患者需要鼻胃管，3 例需要肠外营养。ERAS 组 30 天胃肠道并发症发生率明显低于对照组（13% vs. 27%；p=0.003），POI 发生率也明显低于对照组（7% vs. 23%；p<0.001）。这种效果独立于其他变量（风险比 0.38，95%置信区间 0.18-0.82；p=0.01）。
结论
我们机构的 RC 术后加速康复方案与围手术期 GI 恢复的显著改善和胃肠道并发症发生率的降低显著相关。该方案可在多机构研究中进行测试，以降低 RC 相关的胃肠道发病率。
患者总结
在这项研究中，我们表明，膀胱癌患者接受根治性膀胱切除术的强化康复方案与显著缩短住院时间和降低胃肠道并发症发生率相关，尤其是术后肠梗阻。
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