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中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (06) : 575 -580. doi: 10.3877/cma.j.issn.1674-3253.2023.06.006

临床研究

后腹腔镜根治性肾切除手术时间延长和术中出血量增多的影响因素分析
赵佳晖†(), 王永兴, 彭涛, 李明川, 魏德超, 韩毅力, 侯铸, 姜永光, 罗勇   
  1. 100029　首都医科大学附属北京安贞医院泌尿外科
  • 收稿日期:2022-08-16 出版日期:2023-12-01
  • 通信作者: 赵佳晖

Risk factors of prolonged operation time and higher intraoperative blood loss in retroperitoneal laparoscopic radical nephrectomy

Jiahui Zhao†(), Yongxing Wang, Tao Peng, Mingchuan Li, Dechao Wei, Yili Han, Zhu Hou, Yongguang Jiang, Yong Luo   

  1. Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
  • Received:2022-08-16 Published:2023-12-01
  • Corresponding author: Jiahui Zhao
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引用本文：

赵佳晖, 王永兴, 彭涛, 李明川, 魏德超, 韩毅力, 侯铸, 姜永光, 罗勇. 后腹腔镜根治性肾切除手术时间延长和术中出血量增多的影响因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 575-580.

Jiahui Zhao, Yongxing Wang, Tao Peng, Mingchuan Li, Dechao Wei, Yili Han, Zhu Hou, Yongguang Jiang, Yong Luo. Risk factors of prolonged operation time and higher intraoperative blood loss in retroperitoneal laparoscopic radical nephrectomy[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(06): 575-580.

目的

探讨经腹膜后入路腹腔镜根治性肾切除术（LRN）手术时间延长以及术中出血量增多的影响因素。

方法

回顾性分析北京安贞医院泌尿外科2010年8月至2021年12月接受腹膜后入路LRN患者临床资料，包括年龄、性别、体质量指数（BMI）、既往腹部手术史、肿瘤大小、肿瘤侧别、分期、合并症、术中失血量和手术时间等指标。以手术时间和术中出血量的第75百分位数为分界点，手术时间超过215 min定义为手术时间延长，术中估计出血量超过200 ml定义为出血量增多。应用单因素和多因素Logistic回归分析手术时间延长和术中出血量增多的相关因素，采用受试者工作特征（ROC）曲线评价相关因素对后腹腔镜LRN手术时间延长和出血量增多的预测价值。

结果

本研究共纳入90例腹膜后入路LRN患者，其中22例（24.4%）出现手术时间延长，14例（15.6%）出现术中出血量增多。多因素Logistic回归结果显示术者经验（OR=0.13，P<0.001）是腹膜后LRN手术时间延长的独立危险因素，ROC曲线下面积为0.759，95%置信区间：0.638~0.880。另外，T分期（OR=3.18，P=0.007）和术者经验（OR=0.25，P=0.032）是腹膜后LRN术中出血量增多的独立危险因素，ROC曲线下面积0.769，95%置信区间：0.627~0.910。

结论

腹膜后入路LRN手术时间延长和术中出血量增多与术者手术经验和肿瘤分期有关。

关键词: 腹腔镜, 肾肿瘤, 经腹膜后入路, 根治性肾切除
Objective

To explore the risk factors of prolonged operation time and higher intraoperative blood loss of retroperitoneal laparoscopic radical nephrectomy (LRN).

Methods

The data of patients who underwent retroperitoneal LRN from August 2010 to December 2021 were analyzed retrospectively. Demographic and hospital admission data were collected from these patients with complete medical records. Furthermore, univariate and multivariate logistic analysis were performed to determine the risk factor related to prolonged operation time and increased blood lose following LRN. Receiver operating characteristic (ROC) curve was used to assess the value of risk factors for predicting prolonged operation time and high intraoperative blood loss.

Results

A total of 22 patients (24.4%) had prolonged operation time, and 14 patients (15.6%) had high intraoperative blood loss. The risk factor associated with prolonged operation time in a multivariate analysis was surgical experience (OR=0.13, P<0.001). The area under the ROC curve was 0.759 (95% confidence interval: 0.638-0.880) in the multivariate logistic regression model for predict prolonged operation time. Those associated with high intraoperative blood loss were surgical experience (OR=0.25, P=0.032) and tumor T stage (OR=3.18, P=0.007). The area under the ROC curve was 0.769 (95% confidence interval: 0.627-0.910) in the multivariate logistic regression model for predict high intraoperative blood loss.

Conclusions

Surgical experience and tumor T stage were associated with the risk of prolonged operation time and high intraoperative blood loss.

Key words: Laparoscopy, Renal tumor, Retroperitoneal, Radical nephrectomy
表1 腹膜后入路腹腔镜根治性肾切除术手术时间延长组和对照组一般资料对比
变量 对照组 手术时间延长组 P值
例数 68 22  
年龄[岁，(±s)] 59±11 57±9 0.503
BMI[kg/m2，(±s)] 25.5±4.10 25.5±2.5 0.956
瘤体大小[cm，(±s)] 4.4(3.5，5.6) 4.8(3.7，7.3) 0.357
性别[例(%)]     0.202
男性 46(68) 18(82)  
女性 22(32) 04(18)  
术者经验[例(%)]     <0.0010
≤20例 12(18) 14(64)  
> 20例 56(82) 08(36)  
肿瘤侧别[例(%)]     0.222
左 41(60) 10(45)  
右 27(40) 12(55)  
合并高血压[例(%)]     0.655
否 22(32) 06(27)  
是 46(68) 16(73)  
合并糖尿病[例(%)]     0.540
否 48(71) 14(64)  
是 20(29) 08(36)  
合并冠心病[例(%)]     0.847
否 48(71) 16(73)  
是 20(29) 06(27)  
既往腹部手术[例(%)]     0.501
否 58(85) 20(91)  
是 10(15) 2(9)  
T分期[例(%)]     0.079
T1 56(82) 14(64)  
T2 09(13) 04(18)  
T3~T4 3(4) 04(18)  
切除同侧肾上腺[例(%)]     0.469
否 54(79) 19(86)  
是 14(21) 03(14)  
手术时间跨度[例(%)]     0.112
2010.08~2015.08 41(60) 09(41)  
2015.09~2021.12 27(40) 13(59)  
表2 腹膜后入路腹腔镜根治性肾切除术中出血量增多组和对照组一般资料对比
变量 对照组 出血量增多组 P值
例数 76 14  
年龄[岁，(±s)] 58±11 60±9 0.417
BMI[kg/m2，(±s)] 25.4±3.7 26.0±3.8 0.566
瘤体大小[cm，(±s)] 4.5(3.5，5.6) 4.8(4.0，7.4) 0.253
性别[例(%)]     0.977
男性 54(71) 10(71)  
女性 22(29) 04(29)  
术者经验[例(%)]     0.011
≤20例 18(24) 08(57)  
> 20例 58(76) 06(43)  
肿瘤侧别[例(%)]     0.969
左 43(57) 08(57)  
右 33(43) 06(43)  
合并高血压[例(%)]     0.686
否 23(30) 05(36)  
是 53(70) 09(64)  
合并糖尿病[例(%)]     0.823
否 52(68) 10(71)  
是 24(32) 04(29)  
合并冠心病[例(%)]     0.540
否 55(72) 09(64)  
是 21(28) 05(36)  
既往腹部手术[例(%)]     0.909
否 66(87) 12(86)  
是 10(13) 02(14)  
T分期[例(%)]     0.004
T1 63(83) 07(50)  
T2 10(13) 03(21)  
T3~T4 3(4) 04(29)  
切除同侧肾上腺[例(%)]     0.792
否 62(82) 11(79)  
是 14(18) 03(21)  
手术时间跨度[例(%)]     0.193
2010.08~2015.08 40(53) 10(71)  
2015.09~2021.12 36(47) 04(29)  
表3 腹膜后入路腹腔镜根治性肾切除术手术时间延长及出血量增多的单因素Logistic分析
因素 手术时间延长 术中出血量增多
OR 95%CI P值 OR 95%CI P值
年龄 0.98 0.94~1.03 00.50 1.02 0.97~1.08 0.413
BMI 1.00 0.87~1.14 00.96 1.05 0.90~1.22 0.562
肿瘤直径 1.19 0.93~1.54 00.17 1.16 0.87~1.55 0.308
性别(女) 0.46 0.14~1.54 00.21 0.98 0.28~3.46 0.977
位置(右) 1.82 0.69~4.81 00.23 0.98 0.31~3.09 0.969
高血压 1.28 0.44~3.71 00.66 0.78 0.24~2.59 0.686
冠心病 0.90 0.31~2.63 00.85 1.46 0.44~4.85 0.541
糖尿病 1.37 0.50~3.78 00.54 0.87 0.25~3.04 0.823
手术时间跨度 2.19 0.82~5.84 00.12 0.44 0.13~1.54 0.201
T分期 2.17 1.05~4.49 00.04 3.32 1.49~7.38 0.003
既往腹部手术 0.58 0.12~2.88 00.51 1.1 0.21~5.66 0.909
切除同侧肾上腺 0.61 0.16~2.35 00.47 1.21 0.30~4.91 0.792
术者经验 0.12 0.04~0.36 <0.001 0.23 0.07~0.76 0.016
表4 腹膜后入路腹腔镜根治性肾切除术手术时间延长的多因素Logistic分析
因素 OR 95%CI P值
T分期 2.05 0.91~4.63 0.083
术者经验 0.13 0.04~0.38 <0.001
图1 相关因素预测腹膜后入路腹腔镜根治性肾切除术手术时间延长和出血量增多的ROC曲线注：a为术者经验预测腹腔镜根治性肾切除手术时间延长；b为术者经验联合T分期预测腹腔镜根治性肾切除出血量增多
表5 腹膜后入路腹腔镜根治性肾切除术中出血量增多的多因素Logistic分析
因素 OR 95%CI P值
T分期 3.18 1.38~7.34 0.007
术者经验 0.25 0.07~0.89 0.032
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