目的：探讨腹腔镜根治性膀胱切除术后肠梗阻的诊治措施及预防策略。方法：回顾分析5年来腹腔镜下根治性膀胱切除术及开放手术患者的临床资料。结果：27例发生肠梗阻，23例经保守治疗后好转，4例再次手术。腹腔镜与开放手术后肠梗阻的胃肠功能恢复时间、保守治疗的效果差异无统计学意义。结论：根治性膀胱切除术后肠梗阻一般均表现为小肠梗阻，发生术后肠梗阻的10项防治策略为：（1）正确诊治术后早期炎性肠梗阻；（2）腹膜化；（3）加强围手术期营养支持，控制血糖；（4）减少腹腔引流管的放置，避免气腹压过高；（5）关注小肠坠入盆腔粘连成团的问题；（6）术后早期活动；（7）合理选择尿路改道术式；（8）减少尿漏，提高手术技巧；（9）胃肠减压，防治腹腔间隔室综合征；（10）正确使用相关药物，控制感染。%Objective:To investigate the diagnosis ,treatment and prevention of postoperative ileus of laparoscopic radical cys -tectomy and urinary diversion .Methods:The clinical data of patients who underwent laparoscopic radical cystectomy or laparotomy in past five years were retrospectively analyzed .Results:Twenty-seven patients suffered from intestinal obstruction ,23 cases relieved after conservative treatment ,4 patients underwent re-operation .There were no significant differences between the laparoscopic and open sur -gery for the characteristics of gastrointestinal recovery time ,the effect of conservative treatment .Conclusions:Small intestinal obstruc-tion is the most common obstruction after radical cystectomy .There are ten strategies for the prevention and treatment of ileus after lapa-roscopic radical cystectomy .At first,correct diagnosis and treatment of early postoperative inflammatory bowel obstruction .Second,per-itonealization.Third,perioperative nutritional supporting ,control of blood glucose .Fourth,reduce the time of abdominal cavity drainage tube placement ,control of pneumoperitoneum pressure .Fifth,avoid intestinal adhesion to pelvic cavity .Sixth,early postoperative activi-ty.Seventh,reasonable choice of urinary diversion operation .Eighth,reduce urinary leakage .Ninth,gastrointestinal decompression ,pre-vention and treatment of abdominal compartment syndrome .At last,proper use of perioperative drugs ,control of infection .
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