老年膀胱癌病人机器人辅助根治性全膀胱切除术后早期造口周围潮湿相关性皮肤损伤危险因素分析

doi:10.3969/j.issn.1003-9198.2025.10.020

摘要/Abstract

摘要： 目的分析老年膀胱癌病人机器人辅助根治性全膀胱切除术(RARC)后早期发生造口周围潮湿相关性皮肤损伤(PMASD)的危险因素,以提出针对性优化护理干预对策。方法回顾性分析2016年1月至2024年8月南京医科大学第一附属医院泌尿外科收治的172例老年RARC病人。根据其尿路造口术后是否发生PMASD分为非PMASD组(n=107)及PMASD组(n=65)。比较2组的基本信息、临床资料及造口相关资料。采用多因素logistic回归分析老年膀胱癌病人RARC及尿路造口术后早期发生PMASD的独立影响因素。结果与非PMASD组相比, PMASD组既往放疗病人比例更高,Barthel指数及造口袋更换间隔≥7 d和造口护理行为规范病人比例更低(P<0.05)。多因素logistic回归分析显示,放疗史(OR=5.982,95%CI:2.161~16.560,P<0.001)是PMASD的独立危险因素,高Barthel指数(OR=0.975,95%CI:0.952~0.999,P=0.040)、造口袋更换间隔≥7 d(OR=0.356,95%CI: 0.163~0.776,P=0.009)、造口护理行为规范(OR=0.201,95%CI:0.096~0.422,P<0.001)是PMASD的保护因素。结论放疗史、术后自理能力不足、造口袋更换频繁、造口护理行为不规范是老年RARC病人术后早期发生PMASD的主要诱因。

关键词: 老年人, 机器人辅助根治性全膀胱切除术, 尿路造口, 造口周围潮湿相关性皮肤损伤

Abstract: Objective To explore the risk factors for early peristomal moisture-associated skin damage (PMASD) after robot-assisted radical cystectomy (RARC) and urostomy in the elderly patients with bladder cancer, and to optimize the nursing strategies. Methods A retrospective analysis was performed on 172 elderly patients with RARC admitted to Department of Urology, the First Affiliated Hospital of Nanjing Medical Universiy from January 2016 to August 2024. According to whether PMASD occurred after urostomy, the patients were divided into non-PMASD group (n=107) and PMASD group (n=65). The basic information, clinical data, and ostomy-related data of the two groups were compared. Multivariate logistic regression was used to analyze the independent influencing factors for the early PMASD after RARC and urostomy in the elderly patients with bladder cancer. Results The proportion of patients undergoing radiotherapy was significantly higher and the Barthel index and the proportions of patients with ostomy bag replacement interval ≥7 days and standardized ostomy care behavior were lower in PMASD group than those in non-PMASD group (P<0.05). Multivariate logistic regression showed that radiotherapy history (OR=5.982, 95%CI:2.161-16.560, P<0.001) was an independent risk factor for PMASD, while high Barthel index (OR=0.975, 95%CI:0.952-0.999, P=0.040), ostomy bag replacement interval ≥7 days (OR=0.356, 95%CI: 0.163-0.776, P=0.009), and standardized ostomy care behavior (OR=0.201, 95%CI: 0.096-0.422, P<0.001) were protective factors for PMASD. Conclusions Radiotherapy history, low self-care ability after surgery, high frequency of ostomy bag replacement, and nonstandard stoma care behavior are influencing factors for early PMASD in the elderly patients with bladder cancer after RARC.

Key words: aged, robot-assisted radical cystectomy, urostomy, peristomal moisture-associated skin damage

中图分类号:

R 737.14

蔡天奇, 王雪静. 老年膀胱癌病人机器人辅助根治性全膀胱切除术后早期造口周围潮湿相关性皮肤损伤危险因素分析[J]. 实用老年医学, 2025, 39(10): 1068-1072.

CAI Tianqi, WANG Xuejing. Analysis of risk factors for early peristomal moisture-related skin damage after robot-assisted radical cystectomy in elderly patients with bladder cancer[J]. Practical Geriatrics, 2025, 39(10): 1068-1072.

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