Preliminary analysis of postoperative complications classification and risk factors of transperitoneal laparoscopic treatment for upper urinary tract diseases
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摘要: 目的 探讨经腹腹腔镜上尿路疾病术后并发症分级及相关危险因素。方法 回顾性分析2018年6月1日—2021年3月31日广西医科大学第一附属医院泌尿外科同一术者经腹入路腹腔镜技术治疗127例上尿路疾病患者的临床资料。应用Clavien-Dindo分级系统评估术后并发症发生率和分级，探讨并发症相关危险因素。结果 Clavien-Dindo分级系统评估术后并发症发生率11.02%(14/127)。发生并发症23例次，Ⅰ、Ⅱ、Ⅲ级并发症分别为14、8、1例次，Ⅰ~Ⅱ级占95.60%(22/23)。单因素分析结果显示：患者年龄、性别、体重指数、高血压病、糖尿病、心肺疾病、麻醉ASA分级、手术级别及术中出血量与术后并发症无相关性(P>0.05)，手术时间及术中穿刺通道数量与术后并发症有相关性(P< 0.05)。多因素分析结果显示：手术时间可能是术后并发症的独立危险因素(P< 0.05)。结论 经腹入路腹腔镜上尿路手术术后并发症发生率少，分级低，具有安全性和可行性。手术时间越长，术后发生并发症风险可能越大。
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关键词:
- Clavien-Dindo分级系统 /
- 经腹腹腔镜手术 /
- 术后并发症 /
- 危险因素
Abstract: Objective To investigate postoperative complications and risk factors of transperitoneal laparoscopic treatment for upper urinary tract diseases.Methods The clinical data of 127 patients with upper urinary tract diseases who underwent transperitoneal laparoscopic surgery by the same surgeon in the department of urology of First Affiliated Hospital of Guangxi Medical University between June 1st, 2018 and March 31st, 2021 were retrospectively analyzed. The incidence and classification of postoperative complications were assessed by Clavien-Dindo grading system. The risk factors of postoperative complications were investigated.Results The incidence of postoperative complications was 11.02% (14/127) by Clavien-Dindo grading system. The total of 23 cases/numbers of complications were encountered. There were 14, 8, and 1 cases/numbers of grade Ⅰ, Ⅱ, and Ⅲ complications, respectively. The proportion of grades Ⅰ-Ⅱ accounted for 95.60% (22/23). The results of univariate analysis showed that age, sex, BMI, hypertension, diabetes, cardiopulmonary disease, the grade of American Society of Anesthesia (ASA), operation grade and intraoperative blood loss were not significantly correlated with postoperative complications (P> 0.05). The operation time and the number of trocar during operation were correlated with postoperative complications after surgery (P< 0.05). The results of multivariate analysis demonstrated that operation time was an independent risk factor for postoperative complications (P< 0.05).Conclusion Transperitoneal laparoscopic surgery has less complications and low grade, so it's safe and feasible. The longer the operation time, the greater risk the postoperative complications. -
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表 1 Clavien-Dindo分级系统
分级 定义 Ⅰ级 任何偏离正常康复，但尚不需要特殊药物、手术、内镜或介入治疗的病情变化 包含使用止吐药、退烧药、镇痛药、利尿剂、补充电解质和理疗可以处理的症状及可以在床旁处理的伤口感染。 Ⅱ级 需要药物治疗(Ⅰ级列出的药物除外)的并发症 另外包括输血和全肠外营养。 Ⅲ级 需要手术、内镜或介入治疗的并发症 Ⅲa 不需要全身麻醉 Ⅲb 需要全身麻醉 Ⅳ级 危及生命的并发症(包括中枢神经系统并发症)：需要转重症医学科治疗 Ⅳa 单器官衰竭(包括需要透析的情况) Ⅳb 多器官衰竭 Ⅴ级 死亡 
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表 2 欧洲泌尿外科腹腔镜手术评分系统对手术分级
经腹腹腔镜手术 ESS分级 例数 肾囊肿去顶减压术 E 13 输尿管切开取石术 SD 2 单纯性肾切除术 FD 28 肾上腺肿瘤切除术 FD 27 根治性肾切除术 D 27 肾盂癌根治术 D 8 肾盂输尿管成形术 D 9 腔静脉后输尿管矫形术 D 2 输尿管狭窄段切除+输尿管吻合术 D 1 肾盂输尿管切开取石术 D 2 肾部分切除术 VD 6 输尿管膀胱再植术 VD 2
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表 3 患者术后并发症的Clavien-Dindo分级情况
例次 术后并发症 Ⅰ级 Ⅱ级 Ⅲ级 总计 发热 6 5 0 11 呕吐 3 0 0 3 腹胀 2 1 0 3 肺炎 0 1 0 1 切口感染 3 0 0 3 不全性肠梗阻 0 1 0 1 胰瘘 0 0 1 1 总计 14 8 1 23
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表 4 相关手术并发症汇总情况
手术名称 例次 并发症 病理 肾上腺肿瘤切除术 3 发热、伤口感染、腹胀 肾上腺节细胞神经瘤 单纯性肾切除术 10 发热、呕吐、伤口感染
胰瘘、发热
不全性肠梗阻、腹胀
发热、肺炎肾萎缩
肾萎缩
肾结核
肾结核根治性肾切除术 5 发热
呕吐
发热
发热
呕吐肾嗜酸细胞瘤
肾透明细胞癌
肾透明细胞癌
肾嫌色细胞癌
肾乳头细胞癌肾盂癌根治术 3 发热
发热
腹胀肾盂尿路上皮癌
肾盂尿路上皮癌
肾盂尿路上皮癌腔静脉后输尿管矫形术 1 发热 无 肾部分切除术 1 发热 肾血管平滑肌脂肪瘤
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表 5 术后并发症单因素分析结果
例，M(P25，P75) 项目 发生并发症 未发生并发症 χ2/t P值 年龄/岁 47.0(33.0，63.0) 49.5(37.5，58.0) 0.318 0.750 手术时间/min 181.0(154.0，224.0) 165(132.0，189.0) 2.436 0.015 术中出血量/mL 50.0(20.0，250.0) 30.0(15.0，100.0) 1.662 0.096 性别 0.323 0.570 男 8 51 女 7 61 BMI/(kg·m-2) 1.530 0.125 ＜18.5 2 8 18.5~24.0 10 60 ＞24.0 3 44 高血压病 0.317 0.570 有 3 30 无 12 82 心肺疾病 0.035 0.8500 有 2 17 无 13 95 糖尿病 0.843 0.358 有 0 6 无 15 106 手术级别 2.110 0.060 E 0 13 SD 0 2 FD 5 50 D 9 40 VD 1 7 麻醉ASA分级 0.630 0.528 Ⅰ级 1 8 Ⅱ级 12 79 Ⅲ级 2 25 穿刺通道数量/个 2.018 0.043 3 7 77 4 3 24 5 5 11
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表 6 术后并发症多因素分析结果
变量 β SE Wald χ2 P值 OR 95%CI 手术时间 0.011 0.005 4.524 0.033 1.012 1.001~1.022 穿刺通道数量 0.566 0.334 2.868 0.090 1.761 0.915~3.389
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