Faraj Kassem S, Bunn Weslyn, Durant Adri M, Mauler David, Chang Yu-Hui H, Tyson Mark D
Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA.
Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, USA.
Can J Urol. 2022 Aug;29(4):11209-11215.
The use of alvimopan at the time of cystectomy has been associated with improved perioperative outcomes. Naloxegol is a less costly alternative that has been used in some centers. This study aims to compare the perioperative outcomes of patients undergoing cystectomy with urinary diversion who receive the mu-opioid antagonist alvimopan versus naloxegol.
This was a retrospective review that included all patients who underwent cystectomy with urinary diversion at our institution between 2007-2020. Comparisons were made between patients who received perioperative alvimopan, naloxegol and no mu-opioid antagonist (controls).
In 715 patients who underwent cystectomy, 335 received a perioperative mu-opioid antagonist, of whom 57 received naloxegol. Control patients, compared to naloxegol and alvimopan patients, experienced a significantly (p < 0.05) delayed return of bowel function (4.3 vs. 2.5 vs. 3.0 days) and longer hospital length of stay (7.9 vs. 7.5 vs. 6.5 days), respectively. The incidence of nasogastric tube use (14.2% vs. 12.5% vs. 6.5%) and postoperative ileus (21.6% vs. 21.1% vs. 13.3%) was also most common in the control group compared to the naloxegol and alvimopan cohorts, respectively. A multivariable analysis revealed that when comparing naloxegol and alvimopan, there was no difference in return of bowel function (OR 0.88, p = 0.17), incidence of postoperative ileus (OR 1.60, p = 0.44), or hospital readmission (OR 1.22, p = 0.63).
Naloxegol expedites the return of bowel function to the same degree as alvimopan in cystectomy patients. Given the lower cost of naloxegol, this agent may be a preferable alternative to alvimopan.
膀胱切除术时使用阿维莫潘与围手术期结局改善相关。纳洛西醇是一种成本较低的替代药物，已在一些中心使用。本研究旨在比较接受阿片受体拮抗剂阿维莫潘与纳洛西醇的膀胱切除并尿流改道患者的围手术期结局。
这是一项回顾性研究，纳入了2007年至2020年间在本机构接受膀胱切除并尿流改道的所有患者。对接受围手术期阿维莫潘、纳洛西醇和未接受阿片受体拮抗剂（对照组）的患者进行了比较。
在715例行膀胱切除术的患者中，335例接受了围手术期阿片受体拮抗剂，其中57例接受了纳洛西醇。与纳洛西醇组和阿维莫潘组患者相比，对照组患者的肠功能恢复明显延迟（分别为4.3天、2.5天和3.0天），住院时间更长（分别为7.9天、7.5天和6.5天）（p<0.05）。与纳洛西醇组和阿维莫潘组相比，对照组使用鼻胃管的发生率（分别为14.2%、12.5%和6.5%）和术后肠梗阻的发生率（分别为21.6%、21.1%和13.3%）也最高。多变量分析显示，比较纳洛西醇和阿维莫潘时，肠功能恢复（比值比0.88，p=0.17）、术后肠梗阻发生率（比值比1.60，p=0.44）或再次入院率（比值比1.22，p=0.63）无差异。
在膀胱切除患者中，纳洛西醇可使肠功能恢复的程度与阿维莫潘相同。鉴于纳洛西醇成本较低，该药物可能是阿维莫潘的更优替代选择。
