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剖析根治性膀胱切除术和尿流改道在术后并发症中的作用:利用美国外科医师学院国家手术质量改进计划数据库进行的分析。

Dissecting the role of radical cystectomy and urinary diversion in post-operative complications: an analysis using the American College of Surgeons national surgical quality improvement program database.

机构信息

Department of Urology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.

Department of Urology, Houston Methodist Hospital, Houston, TX, USA.

出版信息

Int Braz J Urol. 2021 Sep-Oct;47(5):1006-1019. doi: 10.1590/S1677-5538.IBJU.2020.1098.

Abstract

OBJECTIVE

To characterize the contribution of the extirpative and reconstructive portions of radical cystectomy (RC) to complications rates, and assess differences between urinary diversion (UD) types.

MATERIALS AND METHODS

We conducted a retrospective cohort study comparing patients undergoing UD alone or RC+UD for bladder cancer from 2006 to 2017 using ACS National Surgical Quality Improvement Program database. The primary outcome was major complications, while secondary outcomes included minor complications and prolonged length of stay. Propensity score matching (PSM) was utilized to assess the association between surgical procedure (UD alone or RC+UD) and outcomes, stratified by diversion type. Lastly, we examined differences in complication rates between ileal conduit (IC) vs. continent UD (CUD).

RESULTS

When comparing RC + IC and IC alone, PSM yielded 424 pairs. IC alone had a lower risk of any complication (HR 0.63, 95% CI 0.52-0.75), venous thromboembolism (HR 0.45, 95% CI 0.22-0.91) and bleeding needing transfusion (HR 0.41, 95% CI 0.32-0.52). This trend was also noted when comparing RC + CUD to CUD alone. CUD had higher risk of complications than IC, both with (56.6% vs 52.3%, p = 0.031) and without RC (47.8% vs 35.1%, p=0.062), and a higher risk of infectious complications, both with (30.5% vs 22.7%, p< 0.001) and without RC (34.0% vs 22.0%, p=0.032).

CONCLUSIONS

RC+UD, as compared to UD alone, is associated with an increased risk of major complications, including bleeding needing transfusion and venous thromboembolism. Additionally, CUD had a higher risk of post-operative complication than IC.

摘要

目的

描述根治性膀胱切除术(RC)的切除术和重建部分对并发症发生率的影响,并评估不同尿路改道术式之间的差异。

材料与方法

我们使用美国癌症协会国家手术质量改进计划数据库,对 2006 年至 2017 年间接受尿路改道术或 RC+UD 的膀胱癌患者进行了回顾性队列研究。主要结局是主要并发症,次要结局包括次要并发症和住院时间延长。采用倾向评分匹配(PSM)评估手术方式(单独尿路改道术或 RC+UD)与结局之间的关联,并按改道术式进行分层。最后,我们比较了回肠导管(IC)与可控性尿流改道术(CUD)之间的并发症发生率差异。

结果

在比较 RC+IC 和 IC 单独治疗时,PSM 产生了 424 对。IC 单独治疗的任何并发症风险较低(HR 0.63,95%CI 0.52-0.75)、静脉血栓栓塞(HR 0.45,95%CI 0.22-0.91)和出血需要输血(HR 0.41,95%CI 0.32-0.52)。当比较 RC+CUD 与 CUD 单独治疗时,也观察到了这种趋势。与 IC 相比,CUD 无论是有(56.6%比 52.3%,p=0.031)还是没有 RC(47.8%比 35.1%,p=0.062),其并发症风险均更高,且感染性并发症风险更高,无论是有(30.5%比 22.7%,p<0.001)还是没有 RC(34.0%比 22.0%,p=0.032)。

结论

与单独尿路改道术相比,RC+UD 与主要并发症(包括输血相关出血和静脉血栓栓塞)风险增加相关。此外,CUD 的术后并发症风险高于 IC。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ab04/8321454/08c91fef0bfa/1677-6119-ibju-47-05-1006-gf01.jpg

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