經腹腔機械手臂輔助攝護腺根除術後常規使用預防性metoclopramide:是否必要?

胡蔚祥、林益聖、歐宴泉、翁瑋駿、黃立華、許兆畬、童敏哲

台中童綜合醫院 外科部 泌尿科

Routine use of prophylactic metoclopramide after transperitoneal robotic-assisted radical prostatectomy: really needed?

Wei-Shiang Hu, Yi-Sheng Lin, Yen-Chuan Ou, Wei-Chun Weng, Li-

Hua Huang, Jow-Yu Hsu, Min-Che Tung

Division of Urology, Department of Surgery,

Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan

Purpose:

To investigate the prevalence of paralytic ileus after transperitoneal robotic-assisted radical prostatectomy (RARP) and to determine the efficacy of prophylactic intravenous metoclopramide in preventing paralytic ileus after transperitoneal RARP.

Materials and methods:

Medical records of 136 patients underwent transperitoneal RARP from January to December 2020 were reviewed. Patients were divided into 2 groups. The case group belonged to the patients with intravenous 10mg metoclopramide every 8 hours for 48 hours perioperatively. The control group included patients without intravenous metoclopramide. Primary outcome: the percentage of case group with symptomatic ileus (sensation of bloating requiring pharmacological treatment) and image-proved ileus (X ray or computed tomography) compared to control group. Secondary outcome: Effect of age, body mass index (BMI), Charlson comorbidity index (CCI) and duration of anesthesia on subjective abdominal distension and image-proved ileus.

Results:

We identified 48 patients in case group and 88 in control group. Basic demographic data were not different. In the case group, 20.8% of patients had symptomatic ileus compared to 36.4% in the control group (p=0.61) and 14.5% of patients had image-proved ileus compared to 12.5% in the control group (p=0.73). The correlation analysis revealed that age was significantly associated with symptomatic ileus (r=0.21, p=<0.05) whereas none of age, BMI, CCI and duration of anesthesia was significantly associated with image-proved ileus.

Conclusion:

The prophylactic metoclopramide to prevent paralytic ileus after transperitoneal RARP were shown to be ineffective. More attention should be given to elderly underwent transperitoneal RARP in case of abdominal bloating.