摘要
目的探讨影响根治性膀胱切除术中失血量的主要因素。方法1996年12月至2008年12月行根治性膀胱切除术233例，男性200例，女性33例。年龄24～79岁，平均58．9岁。分析术前和术中各种因素与失血量的关系，找出影响失血量的主要因素。结果233例手术均取得成功，其中181例开放手术、52例腹腔镜手术。平均手术时间为（339±84）rain，平均失血量为（818±756）ml。单因素分析表明体质量指数（F=9．039）、盆腔手术史（t=-4．365）、麻醉方法（t=3．125）、手术方式（t=6．643）、使用Ligasure（t=6．923）、尿道切除（t=-1．984）与失血量有关（P〈0．05）；多重线性回归分析显示体质量指数（R^2=0．256，P〈0．001）、盆腔手术史（R^2=0．222，P〈0．001）、手术方式（R^2=0．271，P=0．027）、使用Ligasure（R^2=0．172，P〈0．001）是影响失血量的重要因素。176例需要输血（75．5％），输血量（649±569）ml。多元回归分析表明年龄（P=0．010）、性别（P=0．013）、术前贫血（P=0．039）、失血量（P〈0．001）、手术方式（P=0．036）、是否使用Ligasure（P〈0．001）对输血量有明显影响。结论体质量指数、盆腔手术史、手术方式、Ligasure是影响失血量的重要因素，采用腹腔镜及Ligasure手术可能有助于减少术中失血量。
Objective To evaluate factors predictive of blood loss in radical eystectomy in a contemporary series. Methods From December 1996 to December 2008, clinical data of 233 patients who underwent radical cystectomy were reviewed retrospectively. Various preoperative and operative factors were assessed for their association with blood loss using univariate, multivariate regression and correlation analysis. Results One hundred eighty-one patients underwent open radical eysteetomy and 52 cases were treated by laparoscopic radical cystectomy. Overall mean operative time was （339 ±84） minutes, and mean blood loss was （ 818 ± 756 ） ml. On univariate analysis, body mass index （ F = 9. 039 ） , history of pelvic operation （t = - 4. 365） , anesthetic techniques （t = 3. 125 ） , surgical type （ t = 6. 643 ） , use of Ligasure （t =6. 923）, and urethra resection （t = - 1. 984） correlated with blood loss. However, multiple linear regression showed that body mass index （R2 = 0. 256, P 〈 0. 001 ） , history of pelvic operation （R2 = 0. 222, P 〈 0. 001 ） , use of Ligasure （R2 = 0. 172, P 〈 0. 001 ） , and surgical type （ R2 = 0. 271, i6 = 0. 027 ） were significant predictors of blood loss. The transfusion was required in 176 of 233 patients （75.5%） with a median requirement of （649 _＋ 569 ） ml. Likewise logistical regression analysis revealed that older age （OR=3.2, P=0.010）, female gender （OR =33.7, P =0.013）, anemia （OR =6.6, P =0.039）, increased blood loss （OR = 14. 3, P 〈0.001）, open radical eystectomy （OR =6.4, P =0.036） and nonuse of Ligasure （ OR = 10. 1, P 〈 0. 001 ） were predictors of transfusion need. Conclusions Increased body mass index, history of pelvic operation, open radical cysteetomy, and non-use of Ligasure were independent predictors of increased blood loss during radical cystectomy. Such a prediction formula has an important role in identifying high risk patient for increased blood loss and transfusion need before radical cysteetomy.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2012年第9期831-834,共4页
Chinese Journal of Surgery
关键词
膀胱肿瘤
膀胱切除术
失血
手术
Urinary bladder neoplasms
Cystectomy
Blood loss, surgical
