腹腔镜下骶前韧带悬吊联合经会阴盆底重建术治疗子宫切除后膀胱脱垂患者术后并发症发生的危险因素  

Independent risk factors of postoperative complications in patients with bladder prolapse after hysterectomy

作　　者：庞磊[1,2] 丁子俊 邵晋凯[1] 柴红强[1] 吴明 李飞 双卫兵 PANG Lei;DING Zijun;SHAO Jinkai;CHAI Hongqiang;WU Ming;LI Fei;SHUANG Weibing(Department of Urology,Shanxi Provincial People's Hospital,Shanxi Medical University,Taiyuan 030012;The First Clinical Medical College of Shanxi Medical University,Taiyuan 030012;Department of Neonatology,Shanxi Children's Hospital,Taiyuan 030013;Department of Urology,The First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西省人民医院泌尿外科,山西太原030012 [2]山西医科大学第一临床医学院,山西太原030012 [3]山西省儿童医院新生儿科,山西太原030013 [4]山西医科大学第一医院泌尿外科,山西太原030001

出　　处：《现代泌尿外科杂志》2022年第12期1030-1035,共6页Journal of Modern Urology

基　　金：山西省科技合作交流专项项目(No.202104041101035)。

摘　　要：目的探讨预测腹腔镜下骶前韧带悬吊联合经会阴盆底重建术治疗子宫切除术后膀胱脱垂患者术后并发症的独立危险因素并开发其风险计算器。方法收集2011年1月-2022年1月就诊于山西省人民医院泌尿外科、子宫切除术后发生3度以上膀胱脱垂而接受手术治疗的患者在术后3月、6月、12月的随访资料,进行LASSO回归、单变量logistic回归、多变量logistic回归、nomogram构建和校准、ROC曲线分析和拟合优度分析,寻找独立危险因素,并评估预测性能。结果共纳入146例患者,其中发生并发症的有31例,最常见并发症为尿失禁。分析发现使用抗焦虑药、凝血酶原时间活性以及术后首次排尿时间是发生术后并发症的3个独立预测因素。手术方法、下尿路梗阻、抗焦虑药、手术时间、术中出血量、首次排尿时间、凝血酶原时间活性、最大膀胱容量和残余尿量的变量组合具有最好的预测性能。结论腹腔镜下骶前韧带悬吊联合经会阴盆底重建术治疗子宫切除术后膀胱脱垂患者术后并发症的发生率较低。其发生率与凝血酶原活动度、首次排尿时间或抗焦虑药使用独立相关。且以LASSO回归构建的列线图和计算器预测术后并发症概率显示出高度确定性。Objective To predict the independent risk factors and to develop a risk calculator of postoperative complications of laparoscopic anterior sacral ligament suspension(LASLS)combined with dome suspension(DS)in patients with bladder prolapse after hysterectomy.Methods Patients with bladder prolapse of grade III after hysterectomy who received surgery in the Department of Urology of Shanxi Provincial People's Hospital during Jan.2011 and Jan.2022 were enrolled.The patients were followed up 3,6 and 12 months after operation.The incidence of complications was calculated.LASSO regression,univariate Logistic regression,multivariate Logistic regression,nomogram construction and calibration,ROC curve analysis and goodness of fit analysis were carried out.Results A total of 146 patients were included.The most common postoperative complication was urinary incontinence.Use of anti-anxiety drugs,prothrombin time activity and time of first micturition were the independent predictors of complications.The combination of variables,including the surgical approach,lower urinary tract obstruction,use of anti-anxiety drugs,time of operation,intraoperative bleeding volume,time of first micturition,prothrombin time activity,maximum bladder volume and residual urine volume had the best predictive performance.Conclusion This study shows that the incidence of postoperative complications is low.The incidence is independently associated with prothrombin time activity,time of first micturition or use of anti-anxiety drugs.The nomogram and the risk calculator constructed by LASSO regression are highly deterministic in predicting the probability of postoperative complications.

关 键 词：子宫切除 骶前韧带悬吊术 经会阴盆底重建术 膀胱脱垂 并发症 风险计算器 

分 类 号：R695.1[医药卫生—泌尿科学]