目的:探讨根治性膀胱切除术联合原位回肠新膀胱患者术后发生新膀胱相关并发症的影响因素.方法:回顾性分析2010年4月-2022年3月于南京医科大学第一附属医院行根治性膀胱切除术联合原位回肠新膀胱的105例患者的围手术期临床及病理资料.对发生新膀胱相关并发症的影响因素进行分析,并采用受试者工作特征(receiver operating characteristic,ROC)曲线评估白蛋白变化水平及糖尿病对新膀胱相关并发症的诊断效能.结果:共27例患者发生并发症,其中2例患者发生2种并发症,并发症取最高级别,其中发生Clavien-Din-do并发症分级Ⅰ～Ⅱ级18例,Ⅲa级1例,Ⅲb级8例,所有患者经治疗后预后良好.经分析,糖尿病、术后白蛋白水平下降是新膀胱相关并发症的独立危险因素(P＜0.05).术后白蛋白水平的下降和术前罹患糖尿病与术后吻合口瘘发生明显相关(P＜0.05).白蛋白变化结合罹患糖尿病在预测新膀胱相关并发症中的曲线下面积(area under curve,AUC)为 0.752(95％CI:0.650～0.837,P＜0.05),在预测吻合口瘘中的 AUC 为 0.720(95％CI:0.616～0.809,P＜0.05).结论:术后白蛋白水平下降和术前罹患糖尿病是术后发生新膀胱相关并发症的独立危险因素,且与吻合口瘘的发生密切相关.
Analysis of factors influencing neobladder-related complications in orthotopic ileal neobladder
Objective:To investigate the factors influencing the development of neobladder-related complica-tions in patients who underwent radical cystectomy combined with orthotopic ileal neobladder.Methods:There were 27 patients in the complication group,including 18 cases of Clavien-Dindo grading system Ⅰ-Ⅱ,1 case ofⅢ a and 8 cases of Ⅲ b.Two of them experienced two complications.All patients had a good prognosis after treat-ment.The univariate and multivariate logistic analysis indicated that diabetes and postoperative decrease in albu-min level were independent risk factors in neobladder-related complications(P＜0.05).Further analysis of the correlation between the variation of albumin,diabetes and neobladder-related complications was done,which showed that the decrease in postoperative albumin level and the preoperative history of diabetes were significantly correlated with the postoperative anastomotic fistula(P＜0.05).Furthermore,the AUC of the variation of albu-min and preoperative history of diabetes for neobladder-related complications was 0.752(95％CI:0.650-0.837,P＜0.05).And the AUC for postoperative anastomotic fistula was 0.720(95％CI:0.616-0.809,P＜0.05).Conclusion:The decrease in postoperative albumin level and preoperative history of diabetes were independent risk factors in neobladder-related complications and closely related to the occurrence of anastomotic fistula.
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