术前风险评分在膀胱全切尿流改道术中的应用

Application of preoperative risk score in the choice of urinary diversion surgery for bladder cancer patients

摘要:

目的：探讨术前风险评分（preoperative risk score，PRS）对膀胱癌患者选择膀胱全切尿流改道术的应用价值。方法：通过收集2012年1月至2017年5月我院行膀胱全切原位膀胱术、膀胱全切回肠输出道术、膀胱全切输尿管皮肤造口术的膀胱癌患者（共303例）的PRS、并发症综合指数（comprehensive complication index，CCI），分析不同术式的膀胱全切患者PRS值与术后并发症CCI值的相关性，得到PRS预警值，为尿流改道术式选择提供量化依据。结果：①3种手术方式间，输尿管皮肤造口术PRS平均值为0.72±0.23，回肠输出道为0.48±0.24，原位膀胱术为0.34±0.17，经统计分析，差异显著。而3种手术方式间，输尿管皮肤造口术的CCI平均值38.19±16.34，回肠输出道为36.04±11.17，原位膀胱术为38.14±13.36，经统计学分析，无显著性差异。②根据正态分布原理，向左取80%单侧可信区间时，PRS值位于区间外患者的术后并发症的严重程度明显高于该区间内的患者。输尿管皮肤造口术组PRS区间位于 0.34~0.86，PRS＞0.86患者的CCI值明显高于区间内的患者，有统计学差异（P<0.01）；回肠输出道组PRS区间位于0.15~0.60，PRS＞0.86患者的CCI值明显高于区间内的患者，有统计学差异（P<0.01）；原位膀胱术组PRS区间位于0.14~0.42，PRS＞0.42患者的CCI值明显高于区间内的患者，有统计学差异（P<0.05）。结论：PRS大于0.42时不建议选择膀胱全切原位膀胱术；PRS大于0.60时不建议选择膀胱全切回肠输出道术；PRS大于0.86时不建议行膀胱全切输尿管皮肤造口术手术治疗。

Abstract:

Objective：To evaluate the value of preoperative risk score（PRS） for the choice of urinary diversion surgery of bladder cancer patients. Methods：The PRS and comprehensive complication index（CCI） of 303 bladder cancer patients who had undergone urinary diversion surgery（continent ileal reservoir-kock pouch，ileal conduit，cutaneous ureterostomy） from January 2012 to may 2017 in the First Affiliated Hospital of Chongqing Medical University were collected. The relationship between PRS and CCI in the same or different surgeries were analyzed，then the optimized PRS value to lessen the complications of the surgery was chosen，and quantitative evi－dence for the choice of urinary diversion surgery was provided. Results：PRS differed in three urinary diversion surgeries（the average PRS of cutaneous ureterostomy was 0.72±0.23，the average PRS of ileal conduit was 0.48±0.24，and the average PRS of continent ileal reservoir-kock pouch was 0.34±0.17，no statistical differences was observed in CCI between the three surgery（the average CCI of cutaneous ureterostomy was 38.19±16.34，the average CCI of ileal conduit was 36.04±11.17，and the average CCI of continent ileal reservoir-kock pouch was 38.14±13.36. According to the normal distribution principal，when taking the left 80% confidence interval，the postoperative complication out the interval was more serious than that in the interval. The value of left 80% confidence interval PRS was between 0.34 and 0.86 in cutaneous ureterostomy group，the average CCI which out the interval was obviously higher than that inside the interval，and significant differences were captured（P<0.01）. The value of left 80% confidence interval PRS was between 0.15 and 0.60 in ileal conduit group，the av－erage CCI which out the interval was obviously higher than that inside the interval，and significant differences were captured（P<0.01）. The value of left 80% confidence interval PRS was be－tween 0.14 and 0.42 in continent ileal reservoir-kock pouch group，the average CCI which out the interval was obviously higher than that inside the interval，and significant differences were cap－tured（P<0.05）. Conclusion：Continent ileal reservoir-kock pouch is not advised when PRS is beyond 0.42，ileal conduit is not ad－vised when PRS is beyond 0.60，cutaneous ureterostomy is not advised when PRS is beyond 0.86.