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目的探讨根治性膀胱切除术后留置胃肠减压的必要性。方法回顾性分析211例行根治性膀胱切除术患者的临床资料,根据是否留置胃肠减压分为胃肠减压组(18例)和对照组(193例),比较两组的临床效果和并发症情况。结果211例根治性膀胱切除术后有32例发生肠梗阻,占15.2%。其中胃肠减压组有4例发生肠梗阻(22.2%,4/18),对照组有28例发生肠梗阻(14.5%,28/193),两组相比差异无统计学意义(P>0.05)。胃肠减压组和对照组的术后进食时间、住院时间和并发症差异均无统计学意义(P>0.05)。211例患者按术后有无肠梗阻分为肠梗阻组(32例)和无肠梗阻组(179例),两组进食时间分别为9.1和4.9 d,肠梗阻组进食时间明显长于无肠梗阻组(P<0.01),但两组在年龄、性别、手术时间、失血量和住院时间方面差异均无统计学意义(P>0.05)。肠梗阻组有7例肺部感染(21.8%,7/32),无肠梗阻组有3例肺部感染(1.7%,3/179),肠梗阻组肺部感染明显高于无肠梗阻组(P<0.01)。结论根治性膀胱切除术后不留置胃肠减压是安全有效的,且更有利于患者的恢复;围手术期的护理有待进一步改进,以减少术后并发症和缩短住院时间。
Objective To discuss the necessity of decompression after indwelling radical cystectomy. Methods The clinical data of 211 patients undergoing radical cystectomy were retrospectively analyzed. The patients were divided into gastrointestinal decompression group (n = 18) and control group (n = 193) according to whether they were treated with gastrointestinal decompression. The clinical effects and Complications. Results In the 211 cases of radical cystectomy, 32 cases of intestinal obstruction occurred, accounting for 15.2%. Among them, intestinal obstruction was found in 4 cases (22.2%, 4/18) in the gastrointestinal decompression group and intestinal obstruction in 28 cases (14.5%, 28/193) in the control group. There was no significant difference between the two groups (P> 0.05). Gastrointestinal decompression group and control group postoperative eating time, hospital stay and complications were no significant difference (P> 0.05). 211 cases were divided into intestinal obstruction group (n = 32) and no intestinal obstruction group (n = 179) according to the presence or absence of intestinal obstruction. The eating time of the two groups were 9.1 and 4.9 days, and the intestinal obstruction group was significantly longer than the non-intestinal obstruction group (P <0.01). However, there was no significant difference in age, sex, operation time, blood loss and length of hospital stay between the two groups (P> 0.05). In the group of intestinal obstruction, there were 7 cases of pulmonary infection (21.8%, 7/32), 3 cases of pulmonary infection (1.7%, 3/179) in the group without intestinal obstruction, and pulmonary infection in the group of intestinal obstruction (P <0.01). Conclusion It is safe and effective to keep the decompression of the gastrointestinal tract after radical cystectomy, which is more conducive to the recovery of patients. Perioperative nursing needs to be further improved to reduce the postoperative complications and shorten the hospital stay.