2022 年第 10 期 第 17 卷

膀胱癌根治术后肛肠功能障碍发生风险及其预测因素分析

Risk and predictors of anorectal dysfunction after radical cystectomy for bladder cancer

作者：陈江川赵德建张翾张家模

英文作者：Chen Jiangchuan Zhao Dejian Zhang Xuan Zhang Jiamo

单位：重庆医科大学附属永川医院泌尿外科，重庆402160

英文单位：Department of Urology Surgery Yongchuan Hospital of Chongqing Medical University Chongqing 402160 China

关键词：膀胱癌根治术；肛肠功能障碍；肛门静息压力；尿流改道

英文关键词：Radicalcystectomyforbladdercancer;Anorectaldysfunction;Analrestingpressure;Urinarydiversion

• 摘要：

• 目的 探讨膀胱癌根治术后肛肠功能障碍发生风险及其预测因素。方法 选取重庆医科大学附属永川医院2019年8月至2021年1月158例接受膀胱癌根治术患者作为研究对象。术后随访观察1年，根据是否发生肛肠功能障碍分为障碍组和无障碍组。比较2组临床相关资料，应用多因素Logistic回归方法分析术后肛肠功能障碍的预测因素，并绘制受试者工作特征（ROC）曲线验证相关因素的预测价值。结果 随访观察1年，158例患者中6例失访，最终纳入152例，其中42例（27.6%）发生肛肠功能障碍归为障碍组，110例（72.4%）未发生肛肠功能障碍归为无障碍组。障碍组体重指数、术前新辅助放疗比例、回肠导管尿流改道比例均高于无障碍组，术后肛门静息压力低于无障碍组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，体重指数（比值比=1.340，95%置信区间：1.061～1.693）、术前新辅助放疗（比值比=3.127，95%置信区间：1.063～9.203）为膀胱癌根治术患者肛肠功能障碍发生的危险因素，回肠导管尿流改道（比值比=0.242，95%置信区间：0.079～0.741）、术后肛门静息压力（比值比=0.886，95%置信区间：0.843～0.930）为保护因素（均P＜0.05）。ROC曲线分析结果显示，体重指数、术后肛门静息压力、尿流改道、术前新辅助放疗预测术后肛肠功能障碍发生风险的曲线下面积分别为0.754（95%置信区间：0.678～0.821）、0.867（95%置信区间：0.802～0.916）、0.587（95%置信区间：0.504～0.666）、0.676（95%置信区间：0.595～0.749）。结论 膀胱癌根治术后肛肠功能障碍发生风险高，体重指数、术前新辅助放疗、术后肛门静息压力、尿流改道类型可预测术后肛肠功能障碍发生风险。

• Objective  To investigate the risk and predictors of anorectal dysfunction after radical cystectomy for bladder cancer. Methods From August 2019 to January 2021, 158 patients who underwent radical cystectomy for bladder cancer in Yongchuan Hospital of Chongqing Medical University were enrolled. Patients were followed-up for 1 year, and were divided into dysfunction group and non-dysfunction group according to the occurrence of postoperative anorectal dysfunction. The related data of the two groups were compared, and multivariate Logistic regression method was used to analyze the predictors of postoperative anorectal dysfunction. The receiver operating characteristic (ROC) curve was drawn to validate the predictive value of relevant factors. Results After 1 year of follow-up, 6 cases were lost, and 152 cases were included finally. Among them, 42 cases (27.6%) with anorectal dysfunction were classified as dysfunction group, and 110 cases (72.4%) without dysfunction were classified as non-dysfunction group. Body mass index, preoperative neoadjuvant radiotherapy ratio, ileal catheter urinary diversion ratio in dysfunction group were higher than those in non-dysfunction group, postoperative anal resting pressure in dysfunction group was lower than that in non-dysfunction group (all P＜0.05). Multivariate Logistic analysis showed that body mass index (odds ratio=1.340, 95% confidence interval:1.061-1.693) and preoperative neoadjuvant radiotherapy (odds ratio=3.127, 95% confidence interval:1.063-9.203) were risk factors for the occurrence of anorectal dysfunction after radical cystectomy for bladder cancer, and  ileal catheter urinary diversion (odds ratio=0.242, 95% confidence interval:0.079-0.741) and postoperative anal resting pressure (odds ratio=0.886, 95% confidence interval:0.843-0.930) were protective factors (all P＜0.05). The ROC curve analysis showed that the areas under the curve of body mass index, postoperative anal resting pressure, urinary diversion, and preoperative neoadjuvant radiotherapy to predict postoperative anorectal dysfunction were 0.754(95% confidence interval: 0.678-0.821）, 0.867（95% confidence interval: 0.802-0.916), 0.587（95% confidence interval: 0.504-0.666）, and 0.676(95% confidence interval: 0.595-0.749). Conclusions The risk of anorectal dysfunction after radical cystectomy for bladder cancer is high. Body mass index, preoperative neoadjuvant radiotherapy, postoperative anal resting pressure, and type of urinary diversion can predict the risk of postoperative anorectal dysfunction.