后腹腔镜肾上腺肿瘤切除手术时间及术后并发症的影响因素分析及预测模型建立  

Analysis of influencing factors of operative time and postoperative complications of retroperitoneal laparoscopic adrenalectomy and establishment of predicting model

作　　者：刘晓明[1] 吕竟成 朱一辰[1] Liu Xiaoming;Lyu Jingcheng;Zhu Yichen(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,北京100050

出　　处：《国际外科学杂志》2023年第10期670-675,I0005,共7页International Journal of Surgery

摘　　要：目的探讨影响后腹腔镜肾上腺肿瘤切除手术时间和术后并发症的影响因素,并建立相应的预测模型。方法回顾性分析2017年10月—2022年7月于首都医科大学附属北京友谊医院进行后腹腔镜肾上腺肿瘤切除术的298例患者的病例资料。观察并记录患者的手术时间、术后并发症情况,同时记录其可能的影响因素,包括性别、年龄、体重指数(BMI)、肿瘤大小、Mayo黏附概率(MAP)评分、肾上腺肿瘤下极至肾上极的距离(DAK)、肾上腺肿瘤下极至肾蒂的距离(DARP)、皮肤与Gerota筋膜之间的距离(S-GF)、肾周脂肪距离(PNF)、后脂肪指数(PAI)、腰部脂肪厚度、皮下脂肪厚度等。以手术时间为因变量对上述影响因素进行单因素分析,并将其中差异具有统计学意义的变量全部纳入线性回归分析中,进而得出回归方程。再重新以是否出现术后并发症为因变量,上述影响因素为自变量,纳入单因素及多因素Logistic回归分析,得到术后并发症的相关影响因素,并应用R软件建立预测术后并发症风险的列线图模型。结果高BMI(P=0.001)、腰部脂肪厚(P=0.013)、高MAP评分(P<0.001)、高PNF(P<0.001)的男性(P<0.001)患者预计需要的手术时间更长,并得到线性回归方程:手术时间=75.892+4.672×MAP评分+13.574(若为男性)+0.023×BMI+0.792×PNF+1.968×腰部脂肪厚度(P<0.001);多因素Logistic回归分析结果显示,DARP短(P=0.003)、PAI高(P=0.002)、手术时间长(P=0.023)会增加术后并发症的发生风险,并得到术后并发症风险预测列线图模型。同时,当预计手术时间>77.5 min时更容易发生术后并发症。结论本研究建立的后腹腔镜肾上腺肿瘤切除术手术时间和术后并发症的预测模型提供了客观、可靠的评估,当预计手术时间>77.5 min时,手术难度更大,术后并发症发生率更高,应由更有经验的医师进行。Objective To explore the factors affecting the operative time and postoperative complications of retroperitoneal laparoscopic adrenalectomy,and to establish a predicting model.Methods A total of 298 patients who underwent retroperitoneal laparoscopic adrenalectomy at Beijing Friendship Hospital,Capital Medical University from October 2017 to July 2022 were retrospectively analyzed.Observe and record the patient′s operative time,postoperative complications,and record the possible influencing factors,including gender,age,body mass index(BMI),tumor size,Mayo adhesive probability(MAP)score,and distance from the lower pole of the adrenal tumor to the upper pole of the kidney(DAK),distance from the lower pole of the adrenal tumor to the renal pedicle(DARP),distance between the skin and Gerota′s fascia(S-GF),perinephric fat distance(PNF),posterior adiposity index(PAI),thickness of waist fat,thickness of subcutaneous fat,etc.Univariate analysis was performed on the above influencing factors with the operative time as the dependent variable,and all variables with statistical significance were included in the linear regression analysis,and get the regression equation.Then take the occurrence of postoperative complications as the dependent variable,and the above-mentioned influencing factors as independent variables,and incorporate univariate and multivariate Logistic analysis to obtain the relevant influencing factors of postoperative complications,and use R software to establish a risk prediction nomogram model for postoperative complications.Results Male patients(P<0.001)with high BMI(P=0.001),thick waist fat(P=0.013),high MAP score(P<0.001),and high PNF(P<0.001)were expected to require longer operative time,and get the linear regression equation:operative time=75.892+4.672×MAP score+13.574(if male)+0.023×BMI+0.792×PNF+1.968×thickness of waist fat(P<0.001);according to multivariate Logistic regression,short DARP(P=0.003),high PAI(P=0.002),and long operative time(P=0.023)increase the risk of postoperative complica

关 键 词：肾上腺切除术 手术后并发症 预测 手术时间 

分 类 号：R736.6[医药卫生—肿瘤]