摘要
目的探讨经胃管注入医用石蜡对预防根治性膀胱切除术结合回肠膀胱尿流改道术后肠梗阻的临床疗效。方法回顾性统计分析2013年1月至2016年12月于我科行根治性膀胱切除术联合回肠膀胱术患者230例,男性170例,女性60例,年龄28～78岁,平均65.5岁,其中于术后1～3 d连续胃管注入石蜡油患者95例,未注入石蜡油(对照组)患者135例,2组患者在年龄、性别组成、ASA评分、手术方式、手术时间、术中出血量、术后血清白蛋白、术后血钾等指标差异无统计学意义,比较2组患者围手术期肠梗阻的发生率、拔出胃管时间、进食时间、术后住院时间等数据差异,评价使用医用石蜡油预防根治性膀胱切除术联合回肠膀胱术肠梗阻的临床应用价值。统计学处理采用SPSS 21.0软件进行处理。结果所有患者均康复出院,围手术期内无二次手术病例。注入石蜡油组的患者围手术期内肠梗阻的发生率为5.3%(5/95),对照组为13.3%(18/135),2组之间差异有统计学意义(P<0.05)。注入石蜡油组患者平均拔出胃管时间、进食时间、通气时间分别为(3.0±0.8)、(3.5±0.6)、(2.5±1.2) d,对照组分别为(3.8±1.2)、(4.0±0.9)、(2.7±0.4) d。2组患者的平均住院时间分别为(6.8±2.4)、(8.6±3.2) d,差异具有统计学意义(P<0.05)。肠梗阻患者经过常规留置肛管,早期下床活动等处理措施后恢复时间分别为(5.0±1.8)、(8.2±3.1) d,差异具有统计学意义(P<0.05)。结论经胃管注入医用石蜡油能够促进根治性膀胱切除术+回肠膀胱尿流改道术后患者肠道功能的恢复,在预防术后肠梗阻的发生具有显著的疗效,值得进一步推广应用。
Objective To investigate the therapeutic effects of injecting paraffin wax by stomach tubes on the prevention of ileal obstruction after radical cystectomy combined with Bricker urinary diversion.Methods A retrospective analysis of 230 patients who underwent radical cystectomy combined with Bricker urinary diversion in our Department from Jan 2013 to Oct 2016 was made in the study. Of all the patients, 170 were male and 60 were female, with an age between 28 and 78, averaging 65.5 years old. There were 95 patients who were injected with paraffin wax by stomach tubes 1 to 3 days after surgery(the study group), and there were other 135 patients without injection of paraffin wax that were designated as the control group, There were no statistical differences in age, gender, ASA scores, surgical methods, surgical time, perioperative blood loss, postoperative albumin, postoperative blood potassium, when comparisons were made between the 2 groups. Then, the rate of ileal obstruction, the time of stomach tubes extraction, the time of food intake and the length of stay in hospital after surgery were compared between the 2 groups. SPSS 21.0 software was used to perform statistical analysis.Results All the patients recovered and were discharged from hospital, without any cases of secondary surgery during perioperative period. The rate of ileal obstruction in the patients with paraffin wax injection was 5.3%(5/95), while that of the control group was 13.3%(18/135). Statistical significance could clearly be seen, when comparisons were made between them(P<0.05). The time of stomach tube extraction, the time of food intake and the time of gas discharge for the patients with paraffin wax injection were respectively 3.0±0.8 d, 3.5±0.6 d, 2.5±1.2 d, and those of the control group were 3.8±1.2 d, 4.0±0.9 d and 2.7±0.4 d respectively. The length of hospital stay for both groups were 6.8±2.4 d,8.6±3.2 d, respectively, and statistical significance could be noted when comparisons were made between them. Through routine approaches of indwelling decompression tube and early out-of-bed activity, the recovery time of the patients with ileal obstruction was 5.0±1.8 d, 8.2±3.1 d respectively, without statistical significance(P<0.05).Conclusion Paraffin wax injection by stomach tubes could promote recovery of intestinal tract function in the patients undergoing radical cystectomy combined with Bricker urinary diversion, with noticeable efficacy on prevention of ileal obstruction. Therefore, it is worth further clinical extension.
作者
王彤彤
马倩云
王迪
任凭
曹洁
Wang Tongtong;Ma Qianyun;Wang Di;Ren Ping;Cao Jie(Department of Urology,Changhai Hospital Affiliated to Navy Medical University,Shanghai 200433,China)
出处
《海军医学杂志》
2019年第2期159-162,共4页
Journal of Navy Medicine
基金
第二军医大学校级教学研究与改革项目(JYB2015013)
关键词
胃管
石蜡油
肠梗阻
根治性膀胱切除术
Stomach tube
Paraffin wax
Ileal obstruction
Radical cystectomy
作者简介
通信作者:曹洁,电子信箱:celion2004@126.com.
