Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.
Department of Urology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
Int J Urol. 2019 Apr;26(4):493-498. doi: 10.1111/iju.13917. Epub 2019 Feb 1.
To describe the complications and their surgical management after laparoscopic radical cystectomy in a Japanese multicenter cohort.
The participants were drawn from a retrospective multicenter study at 10 institutions. We identified 436 patients who underwent laparoscopic radical cystectomy with no robot assistance. Early and late complications were graded according to their Clavien-Dindo classification. The records of all patients who underwent surgical interventions for laparoscopic radical cystectomy-specific complications were also reviewed. Kaplan-Meier curves were used to describe the time to surgical intervention.
The 90-day rates for overall complications, high-grade complications (Clavien-Dindo classification III-V) and mortality were 53%, 17% and 1.4%, respectively. Gastrointestinal (25%), infectious (22%) and abdominal wall-related (9%) complications were the most common. The late complication rate was 18%, and a total of 81 patients (19%) underwent surgical intervention during the median follow-up period of 22 months. The reoperation rate was 25% at 5 years. Gastrointestinal complications in the early postoperative period and abdominal wall-related complications in the late postoperative period were the main reasons for reoperation. Seven (7%) out of 100 female patients underwent emergent surgical reoperation for transvaginal bowel evisceration as a result of vaginal dehiscence.
Early and late postoperative complications and surgical reoperations are notable after laparoscopic radical cystectomy. Abdominal wall-related complications including vaginal dehiscence are common, and they represent the main indication for reoperation during long-term follow up.
描述日本多中心队列中腹腔镜根治性膀胱切除术的并发症及其手术治疗方法。
参与者来自 10 个机构的回顾性多中心研究。我们共纳入了 436 例未使用机器人辅助的腹腔镜根治性膀胱切除术患者。根据 Clavien-Dindo 分级系统对早期和晚期并发症进行分级。还回顾了所有因腹腔镜根治性膀胱切除术特定并发症而接受手术干预的患者的记录。使用 Kaplan-Meier 曲线描述手术干预的时间。
总体并发症、高级别并发症（Clavien-Dindo 分级 III-V）和死亡率的 90 天发生率分别为 53%、17%和 1.4%。胃肠道（25%）、感染（22%）和腹壁相关（9%）并发症是最常见的。晚期并发症发生率为 18%，在中位随访 22 个月期间，共有 81 例（19%）患者接受了手术干预。5 年内再次手术率为 25%。早期术后胃肠道并发症和晚期术后腹壁相关并发症是再次手术的主要原因。100 例女性患者中有 7 例（7%）因阴道裂开导致阴道肠外露而紧急行手术再次手术。
腹腔镜根治性膀胱切除术后会出现早期和晚期术后并发症和再次手术。包括阴道裂开在内的腹壁相关并发症较为常见，这是长期随访期间再次手术的主要指征。
