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目的:随访观察膀胱癌根治术患者远期并发症,总结代谢性酸中毒的发生情况及临床特点,制定防治策略。方法:回顾性分析我院2008年1月~2013年6月实施膀胱癌根治术37例患者的临床资料,其中开放手术26例,腹腔镜手术11例。研究术后3个月代谢性酸中毒的发生情况。结果:共发现代谢性酸中毒9例(9/37,24.3%),其中原位回肠膀胱术6例(6/21,28.6%),2例较为严重(pH值<7.20);原位乙状结肠膀胱术1例(1/4,25.0%);回肠通道术2例(2/12,16.7%)。9例酸中毒患者尿液检查均合并尿路感染,其中7例合并低血钾(2.25~3.18mmol/L),6例合并不同程度肾功能不全(130~465μmo/L),仅1例合并高血氯(>120mmol/L)。9例患者均采用保守治疗,通过留置尿管、利尿、应用抗生素、静脉滴注碳酸氢钠或口服碳酸氢钠片,均在1周内治愈。结论:肠代膀胱术后远期代谢性酸中毒并发症常常难以避免,但结果多不严重,并可通过优化手术方式,预防尿路感染,促进储尿囊的排空,从而降低其发生。治疗上多以保守治疗为主。
Objective: Follow-up observation of long-term complications of patients with radical resection of bladder cancer, summarize the occurrence of metabolic acidosis and clinical features, to develop prevention and treatment strategies. Methods: The clinical data of 37 patients undergoing radical mastectomy of bladder cancer from January 2008 to June 2013 in our hospital were retrospectively analyzed. Among them, 26 were open surgery and 11 were laparoscopic surgery. Study 3 months after the occurrence of metabolic acidosis. Results: Metabolic acidosis was found in 9 cases (9 / 37,24.3%), of which 6 cases (6 / 21,28.6%) were in situ ileal bladder surgery and 2 cases were more severe (pH <7.20) Bladder surgery in 1 case (1/4, 25.0%); ileal approach in 2 cases (2/12, 16.7%). Nine cases of acidosis patients with urinary tract infection were complicated by urinary tract infection, including 7 cases of hypokalemia (2.25 ~ 3.18mmol / L), 6 cases of varying degrees of renal insufficiency (130 ~ 465μmo / L), only 1 case of merger High blood chlorine (> 120mmol / L). All 9 patients were treated conservatively and were cured within 1 week through indwelling catheter, diuretic, antibiotics, intravenous sodium bicarbonate or oral sodium bicarbonate. Conclusion: The complications of long-term metabolic acidosis after intestinal metaplastic bladder surgery are often difficult to avoid. However, the results are not serious enough. More treatment based on conservative treatment.