Risk factors for postoperative ileus after robot-assisted radical cystectomy with intracorporeal urinary diversion
Risk factors for postoperative ileus after robot-assisted radical cystectomy with intracorporeal urinary diversion
复制标题
机器人辅助膀胱根治术体内尿流改道术后肠梗阻的危险因素
作者：
Zennami K;Sumitomo M;Hasegawa K;Kozako M;Takahara K;Nukaya T;Takenaka M;Fukaya K;Ichino M;Fukami N;Sasaki H;Kusaka M;Shiroki R.
目的探讨机器人辅助下膀胱癌根治术联合体内尿流改道术后发生肠梗阻的危险因素。方法对2011年至2021年间藤田卫生大学收治的78例膀胱癌患者进行回顾性分析。比较有无肠梗阻的队列患者的基线特征和围手术期结果。结果78例患者中，20例(25.6%)发生术后肠梗阻。与非肠梗阻组相比，肠梗阻组老年人8分显著降低(P= 0.003)，腹部/盆腔手术率高(P= 0.04)。在肠梗阻队列中观察到肠道重建时间、住院时间、活动时间、液体摄入量、固体摄入量、排气和大便均显著延长。Logistic回归分析结果显示，老年8岁总分(P= 0.009)、活动时间(P= 0.03)和液体摄入时间(P= 0.004)是术后肠梗阻的独立预测因素。在预测术后肠梗阻的模型中，受试者操作特征曲线下面积为0.716，老年8分总和的分界值为13。结论早期活动、早期补液、老年8分评分低是术后肠梗阻的重要危险因素。术前老年-8评估是预测术后肠梗阻的有用工具。术后全面加强恢复，包括关键部件，可能有助于肠道恢复和防止随后的肠梗阻。
ObjectivesTo evaluate the risk factors for postoperative ileus in patients who underwent robot‐assisted radical cystectomy with intracorporeal urinary diversion.MethodsWe retrospectively analyzed 78 patients with bladder cancer who underwent robot‐assisted radical cystectomy with intracorporeal urinary diversion at Fujita Health University between 2011 and 2021. Baseline characteristics and perioperative outcomes were compared between the cohorts with and without ileus. Logistic regression analysis was used to identify the risk factors for postoperative ileus.ResultsOut of the 78 patients included in this study, 20 (25.6%) developed postoperative ileus. The ileus cohort was associated with a significantly lower Geriatric‐8 score (P= 0.003) and a higher rate of previous abdominal/pelvic surgery (P= 0.04) compared with those of the nonileus cohort. Significantly longer intestinal tract reconstruction time, hospital stay, time to mobilization, fluid intake, solid intake, flatus, and stool were observed in the ileus cohort. According to the results of the logistic regression analysis, the Geriatric‐8 sum (P= 0.009), time to mobilization (P= 0.03), and time to fluid intake (P= 0.004) were independent predictors of postoperative ileus. In the model predicting postoperative ileus, the area under the receiver operating characteristic curve was 0.716, and the cutoff value of the Geriatric‐8 sum was 13.ConclusionsEarly mobilization and fluid intake and low Geriatric‐8 scores were significant risk factors for postoperative ileus. Preoperative Geriatric‐8 evaluation is a useful tool for predicting postoperative ileus. Comprehensive enhanced recovery after surgery, including key components, may help bowel recovery and prevent subsequent ileus.