根除性膀胱切除術與尿路分流重建手術的傷口併發症的危險因素
王曦賢、蕭博任、陳冠亨、張議徽、吳錫金、黃志平、葉進仲、陳汶吉、鄒頡龍、楊啟瑞、張兆祥
中國醫藥大學附設醫院 泌尿部
Risk factors of wound complication after radical cystectomy with urinary divertion
Hsi-Hsien Wang, Po-Jen Hsiao, Guang-Heng Chen, Yi-Huei Chang, Hsi-Chin Wu, Chi-Ping Huang, Chin-Chung Yeh, Wen-Chi Chen, Chieh-Lung Chou, Chi-Rei Yang, Chao-Hsiang Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Purpose: Hernia, wound poor healing and wound dehiscence are common wound complication following radical cystectomy and urinary diversion. We collecting the clinical and radiological evidence for stomal hernia, incisional hernia, wound poor healing and wound dehiscence. Our purpose is to investigate their risk factors in our single center experience.
Materials and Methods: We reviewed the records of 1,101 patients who underwent radical cystectomy from 2004 to 2016 from CMUH data base. There were 275 patients underwent radical cystectomy, and 97 patient’s received urinary diversion reconstruction. 77 patient’s underwent ileal conduit and studer pouch for 20 patients. Patients were followed with computerized tomography surveillance, which te hernias were defined by radiologists, and physical finding of hernia clinically. The stomal and incisional hernias were defined by radiologist. The poor wound healing cases and wound dehiscence patients were also included clinically, who had possibility of hernia development. We investigated the risks including characteristic of sex, age, body weight, height, BMI, smoking. The comorbidities were COPD, DM, previous abdominal surgery, previous radiation therapy and ESRD. The treatment related risk factors were neoadjuvant chemotherapy and estimated blood loss during surgery. Logistic regression was done to identify independent predictors.
Results: Stomal hernia was diagnosed in 5 of 97 patients (5.2%) with a mean age at diagnosis of 64.8 years. Incisional hernia was present in 9 patients (9.3%) with a mean age at diagnosis of 68.56 years. 2 patients (2.1%) with poor wound healing and 5 patients (5.2%) with wound dehiscence. 11 patients with those wound complications were men, and 10 were women. The logistic regression showed
significant associations of wound complication with height and studer pouch.
Conclusions: Wound complications are common after cystectomy with urinary diversion. Height and studer pouch diversion type are risk factors for those wound complications. Large prospective studies is need for further risk factors evaluation.