Study of early postoperative complications between intracorporeal and extracorporeal ileal conduit after robot-assisted radical cystectomy
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摘要: 目的比较机器人辅助下根治性膀胱切除术(RARC)后全腹腔内回肠通道术(ICIC)与腹腔外回肠通道术(ECIC)的术后早期并发症。方法回顾性分析我院2016年10月-2022年4月围手术期接受加速康复方案的机器人辅助下RARC+回肠通道术的54例膀胱癌患者资料，其中ICIC组21例，ECIC组33例，对两组患者的基本资料、围手术期数据及术后早期并发症进行分析对比。结果ICIC组与ECIC组性别(P < 0.001)及手术时间(335 min vs.400 min，P=0.028)差异有统计学意义，在BMI、随访时间、美国麻醉师协会(ASA)评分、肿瘤病理T分期、N分期、住院天数、术中失血量、淋巴结清扫个数及术后早期并发症等方面差异无统计学意义。术后早期并发症发生率ICIC组为23.8%(5/21)，ECIC组为45.5%(15/33)。术后不全性肠梗阻置入胃管发生率ICIC组为9.5%(2/21)，ECIC组为21.2%(7/33)。结论ICIC在降低肠道相关并发症方面可能存在潜在的临床意义，仍需积累样本量和进一步随访来验证。
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关键词:
- 膀胱癌 /
- 机器人辅助下根治性膀胱切除术 /
- 全腹腔内回肠通道术
Abstract: ObjectiveTo compare early postoperative complications between intracorporeal ileal conduit(ICIC) and extracorporeal ileal conduit(ECIC) after the treatment of robot-assisted radical cystectomy(RARC).MethodsThe data of 54 patients with bladder cancer who received RARC+ ileal tunnel surgery and enhanced recovery after surgery in our hospital from October 2016 to April 2022 were retrospectively analyzed, including 21 cases in ICIC group and 33 cases in ECIC group. The basic data, perioperative data, and early postoperative complications of the patients were analyzed and compared.ResultsThere were significant differences in gender(P < 0.001) and operation time(335 min vs. 400 min, P=0.028) between ICIC group and ECIC group, while there was no difference in BMI, follow-up time, ASA score, tumor pathological T stage, N stage, hospital stay, intraoperative blood loss, number of lymph node dissections, or early postoperative complication. The incidence of early postoperative complications was 23.8%(5/21) in ICIC group and 45.5%(15/33) in ECIC group. The incidence of postoperative incomplete intestinal obstruction with gastric tube placement was 9.5%(2/21) in ICIC group and 21.2%(7/33) in ECIC group.ConclusionICIC may have potential clinical significance to reduce intestinal-related complications, which still needs to be verified by accumulating sample size and further follow-up. -
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表 1 ICIC组和ECIC组患者一般资料比较
例(%)，M(P25，P75) 项目 ICIC组(21例) ECIC组(33例) P值 年龄/岁 75(64.0，83.0) 73(66.0，78.0) 0.282 BMI/(kg·m-2) 24.3(20.6，26.2) 23.1(20.5，25.6) 0.320 随访时间/月 17.0(6.0，26.5) 18.0(7.0，33.0) 0.915 性别 < 0.001 男 6(28.57) 27(81.82) 女 15(71.43) 6(18.18) ASA评分 0.713 2分 15(71.43) 22(66.67) 3分 6(28.57) 11(33.33) 腹腔盆腔手术史 6(28.57) 9(27.27) 0.917 吸烟史 5(23.81) 20(60.61) 0.008 新辅助化疗史 2(9.52) 6(18.18) 0.631 T分期 0.876 T0~T2 11(52.38) 18(54.55) T3~T4 10(47.62) 15(45.45) N分期 0.661 N0 16(76.19) 28(84.85) N+ 5(23.81) 5(15.15) 
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表 2 ICIC组和ECIC组Clavien-Dindo各级并发症比较
例(%) Clavien-Dindo分级 ICIC组(21例) ECIC组(33例) 治疗 0级 16(76.19) 18(54.55) Ⅰ级 2(9.52) 8(27.27) 疼痛 2(9.52) 5(15.15) 药物镇痛 切口感染 0(0) 1(3.03) 清创换药 发热 0(0) 1(3.03) 解热药物 呕吐 0(0) 1(3.03) 止吐药物 Ⅱ级 2(9.52) 7(21.21) 肠梗阻 2(9.52) 7(21.21) 置胃管 贫血 0(0) 1(3.03) 输血 低蛋白血症 0(0) 1(3.03) 输入人血白蛋白 Ⅲb级 1(4.76) 1(3.03) 肠梗阻 0(0) 1(3.03) (全身麻醉)内镜下置小肠梗阻管 腹腔出血 1(4.76) 0(0) (全身麻醉)腹腔探查止血 Ⅳa级 0(0) 1(3.03) Ⅰ型呼吸衰竭合并肺部感染及胸水 0(0) 1(3.03) 转入ICU Ⅳb级 0(0) 2(6.06) 肠瘘伴腹腔复杂性感染，消化道出血 0(0) 1(3.03) 转入ICU 输尿管吻合口瘘，多器官功能衰竭 0(0) 1(3.03) 转入ICU 注：ECIC组中有4例患者合并两种及以上并发症，其中1例肠梗阻置入胃管无效后进一步置入小肠梗阻管。
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表 3 ICIC组和ECIC组围手术期数据
例(%)，M(P25，P75) 项目 ICIC组(21例) ECIC组(33例) P值 术后住院时间/d 13(11，16) 14(11，17) 0.443 术中出血/mL 350(200，445) 400(250，800) 0.063 手术时间/min 335(288.5，402.5) 400(342.5，477.0) 0.028 淋巴结清扫个数 20(12，27) 17(13，22) 0.440 肠梗阻置胃管 2(9.5) 7(21.2) 0.454 Clavien-Dindo分级 0.266 0 16(76.2) 18(54.5) Ⅰ~Ⅱ 4(19.0) 11(33.3) Ⅲ~Ⅳ 1(4.8) 4(12.2)
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