目的:探讨行腹腔镜无功能肾切除患者的临床特征,分析合并上尿路手术史和无手术史患者之间影响手术复杂性的相关因素.方法:收集2017年1月至2023年11月于重庆医科大学附属第一医院泌尿外科接受腹腔镜无功能肾切除术患者的临床资料,回顾性分析上尿路手术史和无手术史患者的一般特征以及围手术期指标的变化.采用手术时间、估计失血量、中转开放手术率、术后并发症、术后住院时间等指标,评估腹腔镜单纯性肾切除手术的复杂性.结果:共纳入293例患者,其中94例合并上尿路手术史以及199例无手术史.与无手术史组相比,上尿路手术史组的估计失血量、中转开放手术率、手术时间均有所增加(P＜0.001),而术后住院时间则无明显差异.在单因素方式分析中,上尿路手术史(P＜0.001)是唯一影响估计失血量的因素.logistic 回归模型显示上尿路手术史(OR=3.858,95％CI=1.796～8.287,P=0.001)和体质指数(body mass index,BMI)(OR=4.074,95％CI=1.887～8.796,P=0.001)是影响手术时间延长的独立预测因素.结论:腹腔镜单纯性肾切除术的复杂程度受多种因素影响.上尿路手术史是影响手术时间及估计失血量的独立因素.对于合并上尿路手术史患者,根据患者的临床特点合理的选择手术方式和治疗策略十分重要.
Difficulty prediction and risk factor analysis of laparoscopic simple nephrectomy
Objective:To investigate the clinical characteristics of patients undergoing laparoscopic nonfunctional nephrectomy and to analyze the factors associated with the complexity of the procedure between patients with and without a history of upper urinary tract surgery.Methods:Clinical data of patients who underwent laparoscopic nonfunctional nephrectomy at The First Affiliated Hospital of Chongqing Medical University between January 2017 and November 2023 were collected to retrospectively analyze the general charac-teristics of patients with and without a history of upper urinary tract surgery as well as changes in perioperative indicators.The complex-ity of laparoscopic simple nephrectomy was assessed using indicators such as operative time,estimated blood loss,rate of intraoperative conversion to open nephrectomy,postoperative complications,and postoperative hospitalization time.Results:A total of 293 patients were included and 94 of these patients had a history of upper urinary tract surgery.Estimated blood loss,rate of intraoperative conver-sion to open nephrectomy,and operative time were increased in patients with a history of upper urinary tract surgery compared with pa-tients without such surgery(P＜0.001),whereas there was no significant difference in postoperative hospitalization time.In the univari-ate analysis,history of upper urinary tract surgery(P＜0.001)was the only factor affecting estimated blood loss.Logistic regression mod-els showed that history of upper urinary tract surgery(OR=3.858,95％CI=1.796-8.287,P=0.001)and body mass index(OR=4.074,95％CI=1.887-8.796,P=0.001)were independent predictors of prolonged operative time.Conclusion:The complexity of laparoscopic simple nephrectomy is influenced by several factors.History of upper urinary tract surgery is an independent factor affecting operative time and estimated blood loss.In treatment of patients with a history of upper urinary tract surgery,it is important to rationally select the surgical approach and treatment strategy based on their clinical characteristics.
万方数据
维普
