腹腔镜根治性前列腺切除术后吻合口漏尿的危险因素分析  

Identification of risk factors for urethrovesical anastomotic leakage following laparoscopic radical prostatectomy

作　　者：陈昊天 张文涛 毛士玉 顾卓然 邹立斌 艾麦提阿吉·喀迪尔 郭长城[1] 杨斌[1] 姚旭东[1] Chen Haotian;Zhang Wentao;Mao Shiyu;Gu Zhuoran;Zou Libin;Aimaitiaji·Kadier;Guo Changcheng;Yang Bin;Yao Xudong

机构地区：[1]同济大学附属第十人民医院泌尿外科同济大学医学院泌尿肿瘤研究所,上海200072

出　　处：《中华泌尿外科杂志》2023年第3期167-172,共6页Chinese Journal of Urology

摘　　要：目的探讨腹腔镜根治性前列腺切除术后吻合口漏尿的危险因素。方法回顾性分析2021年1—12月同济大学附属第十人民医院收治的292例行腹腔镜根治性前列腺切除术患者的临床资料。根据术后是否有吻合口漏尿,将患者分为漏尿组(27例)和无漏尿组(265例)。漏尿组与无漏尿组患者年龄[(71.5±6.5)岁与(70.2±6.4)岁]、体质量指数[(24.5±3.6)kg/m^(2)与(24.2±3.0)kg/m^(2)]、前列腺体积[40(27.3,63.2)ml与38(28.1,56.2)ml]、Gleason评分(≤6、7、8、9分分别为:2、12、3、10例与20、153、25、67例)、临床分期(T1~T4期:0、16、9、2例与4、145、102、14例)和风险分级(低、中、高危:0、2、25例与9、17、239例)差异均无统计学意义(P>0.05),但漏尿组的总前列腺特异性抗原(tPSA)显著高于无漏尿组[20.0(9.6,79.0)ng/ml与13.7(8.5,25.0)ng/ml,P=0.049]。采用倾向性评分匹配(PSM)对漏尿组和无漏尿组上述指标进行1∶1匹配,使两组基线均衡。比较匹配后的两组患者围手术期相关指标。选取有统计学意义的指标纳入单因素和多因素logistic回归,分析根治性前列腺切除术后吻合口漏尿的危险因素。绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析各因素预测漏尿的准确性。结果采用倾向性评分匹配后,24对匹配成功,即两组各24例。漏尿组较无漏尿组的膜部尿道长度(MUL)更短[(15.5±2.2)mm与(17.5±1.5)mm,P<0.001],膜部尿道宽度(UWT)更窄[(9.5±1.9)mm与(10.6±1.5)mm,P=0.024],尿道膀胱颈吻合时间更长[(21.6±4.1)min与(16.9±2.9)min,P<0.001],注水试验失败率更高[16.7%(4/24)与4.2%(1/24),P=0.045]。多因素logistic回归分析结果显示,MUL短(OR=0.544,95%CI 0.335~0.884,P=0.014)、UWT窄(OR=0.538,95%CI 0.313~0.924,P=0.025)和尿道膀胱颈吻合时间长(OR=1.519,95%CI 1.122~2.110,P=0.009)为吻合口漏尿的独立危险因素。ROC曲线分析结果显示,MUL、UWT、吻合时间的AUC分别为0.789(95%CI 0.651~0.927)、0.715(95%CI 0.562Objective To investigate the risk factors of urethrovesical anastomotic leakage after laparoscopic radical prostatectomy.Methods The clinical data of 292 patients who underwent laparoscopic radical prostatectomy in the Tenth People's Hospital Affiliated to Tongji University from January to December 2021 were retrospectively analyzed.According to whether there was anastomotic leakage,the patients were divided into leakage group(27 cases)and non-leakage group(265 cases).There were no significant differences in age[(71.5±6.5)years vs.(70.2±6.4)years],body mass index[(24.5±3.6)kg/m^(2) vs.(24.2±3.0)kg/m^(2)],prostate volume[40(27.3,63.2)ml vs.38(28.1,56.2)ml],Gleason score,clinical stage,and risk classification between the leakage group and the non-leakage group(P>0.05),but the total prostate-specific antigen in the leakage group was significantly higher than that in the non-leakage group[20.0(9.6,79.0)ng/ml vs.13.7(8.5,25.0)ng/ml,P=0.049].Propensity score matching(PSM)was used to match the above indicators between the leakage group and the non-leakage group as 1∶1,so that the baseline of the two groups was balanced.The perioperative indicators of the matched two groups of patients were compared and analyzed.Statistically significant indicators were selected and included in univariate and multivariate logistic regression to analyze the risk factors of anastomotic leakage after radical prostatectomy.Finally,the receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was calculated.The accuracy of each factor in predicting urine leakage was obtained.Results After PSM,24 cases were successfully matched.The leakage group had shorter membranous urethral length(MUL)[(15.5±2.2)mm vs.(17.5±1.5)mm,P<0.001],thinner membranous urethral wall thickness(UWT)[(9.5±1.9)mm vs.(10.6±1.5)mm,P=0.024],longer anastomotic time of urethrovesical neck[(21.6±4.1)min vs.(16.9±2.9)min,P<0.001]and higher failure rate of water injection test[16.7%(4/24)vs.4.2%(1/24),P=0.045]than the non-leakage group.The

关 键 词：前列腺切除术 吻合口漏尿 危险因素 倾向性评分匹配 

分 类 号：R699.8[医药卫生—泌尿科学]