机器人辅助肾部分切除术出血性并发症预测因素分析  

Predictive factors in hemorrhagic complications following robotic-assisted partial nephrectomy

作　　者：林博涵 邱钱仁顺 高睿承 许宁[1] 薛学义[1] 孙雄林[1] 郑清水[1] 魏勇[1] 陈少豪 LIN Bohan;QIU Qianrenshun;GAO Ruicheng;XU Ning;XUE Xueyi;SUN Xionglin;ZHENG Qingshui;WEI Yong;CHEN Shaohao(Department of Urology,First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院泌尿外科,福州350005

出　　处：《现代泌尿生殖肿瘤杂志》2024年第2期70-74,共5页Journal of Contemporary Urologic and Reproductive Oncology

摘　　要：目的分析接受机器人辅助肾部分切除术(RAPN)的肾肿瘤患者发生出血性并发症(HCs)的风险预测因素。方法分析2021年3月至2023年1月间接受RAPN的317例患者的临床、手术及术后病理资料,将术后血红蛋白下降>3 g/dl、术后需要输血、治疗性干预的动静脉瘘或假性动脉瘤的患者纳入出血组,其余纳入无出血组。通过倾向性评分匹配法(PSM)均衡组间混杂因素,通过单因素及多因素Logistic回归分析确定RAPN后HCs的独立预测因子。结果纳入的317例患者中,29例患者术后出现HCs。经过PSM控制纳入研究参数的一致性,将27例RAPN后HCs与27例无HCs的患者进行匹配。单因素Logistic回归分析提示,R.E.N.A.L.评分≥10分(OR=5.92,95%CI=2.36~14.82)、手术时间≥130 min(OR=6.21,95%CI=1.94~19.84)及热缺血时间≥23 min(OR=3.60,95%CI=1.42~9.13)是RAPN后HCs的影响因素,进一步多因素Logistic回归分析显示,R.E.N.A.L.评分≥10分(OR=5.03,95%CI=2.78~9.10)、手术时间≥130 min(OR=1.02,95%CI=1.01~1.03)及热缺血时间≥23 min(OR=1.15,95%CI=1.05~1.26)是RAPN后HCs的危险因素。结论术前R.E.N.A.L.评分≥10分、手术时间≥130 min及热缺血时间≥23 min的患者更有可能在RAPN后发生HCs。Objective To analyze the predictive factors in hemorrhagic complications(HCs)following robot-assisted partial nephrectomy(RAPN)in renal tumor patients.Methods The basic clinical,surgical,and postoperative pathological data of 317 patients undergoing RAPN between March 2021 and January 2023 were analyzed.Patients with postoperative hemoglobin decrease>3g/dl,arterial venous fistula or pseudoaneurysm requiring blood transfusion or therapeutic intervention were included in the bleeding group.Propensity score matching(PSM)balanced confounding factors between groups,and independent predictors of HCs after RAPN were determined through univariate and multivariate logistic regression analyses.Results Of the 317 patients included in this study,29(9.15%)had HCs.After ensuring parameter consistency through PSM control,27 cases of patients with HCs after RAPN were matched with 27 cases of patients without HCs.Univariate logisticregression analysis showed that R.E.N.A.L.score≥10(OR=5.92,95%CI=2.36-14.82),surgical time≥130 minutes(OR=6.21,95%CI=1.94-19.84),and warm ischemia time≥23 minutes(OR=3.60,95%CI=1.42-9.13)are significant factors influencing the occurrence of HCs after RAPN.Multivariate logistic regression analysis showed that R.E.N.A.L.score≥10(OR=5.03,95%CI=2.78-9.10),operative time≥130 minutes(OR=1.02,95%CI=1.01-1.03)and warm ischemia time≥23 minutes(OR=1.15,95%CI=1.05-1.26)were independent risk factors for HCs after RAPN.Conclusions Patients with preoperative R.E.N.A.L.score≥10,operative time≥130 minutes and warm ischemia time≥23 minutes are more likely to have HCs after RAPN.

关 键 词：机器人辅助肾部分切除术 R.E.N.A.L评分 出血性并发症 

分 类 号：R737.11[医药卫生—肿瘤]