机器人辅助根治性膀胱切除术患者术后早期并发症危险因素分析及应对策略研究  

Risk factors and coping strategies for early postoperative complications in patients undergoing robot-assisted radical cystectomy

作　　者：费媛媛 陈慧[1] 张银 庄君龙[1] FEI Yuanyuan;CHEN Hui;ZHANG Yin;ZHUANG Junlong(Department of Urology,Drum Tower Hospital Affiliated to Medical School of Nanjing University,Nanjing 210000,China)

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,江苏南京210000

出　　处：《机器人外科学杂志(中英文)》2025年第1期101-106,共6页Chinese Journal of Robotic Surgery

基　　金：国家自然科学基金(81974394)。

摘　　要：目的:探究机器人辅助根治性膀胱切除术(RARC)患者术后早期并发症的危险要素,并制定相应优化措施。方法:选择南京大学医学院附属鼓楼医院于2022年1月—2023年12月行RARC的140例患者作为研究对象。根据患者术后90d内是否出现早期并发症分为并发组(55例)和无并发组(85例)。收集并比较两组患者人口学资料、病情相关资料、手术相关资料。行Logistic回归单因素、多因素分析筛选患者术后早期并发症风险要素,评估相关危险因素预测术后早期并发症效能,提出针对性的管理策略。结果:与无并发组相比,并发组患者术前SCr水平更高,术前白蛋白水平更低,术中出血量更多,术后静脉抗生素使用时间更短,合并糖尿病史人数占比更多(P<0.05)。多因素Logistic回归分析显示,术前SCr水平高、术前白蛋白水平低、术中出血量大、术后静脉抗生素使用时间过短是RARC患者术后早期并发症发生的独立危险因素(P<0.05)。术前SCr、术前白蛋白、术中出血量、术后静脉抗生素使用时间的预测曲线AUC值分别为0.851、0.789、0.742、0.823,提示上述因素均对早期并发症发生有一定预测价值。结论:术前SCr水平高、术前白蛋白水平低、术中出血量大、术后静脉抗生素使用时间过短均会增加RARC患者术后早期并发症发生风险,需针对性给予临床管理措施,预防术后早期并发症。Objective:To explore the risk factors of early postoperative complications in patients who underwent robot-assisted radical cystectomy(RARC)and create corresponding optimization measures.Methods:140 patients who underwent RARC from Jan.2022 to Dec.2023 at Drum Tower Hospital Affiliated to Medical School of Nanjing University were selected and divided into the complication group(n=55)and the non-complication group(n=85)according to whether they developed early complications within 90 d after surgery.The demographic data,condition-related data,and surgery-related data were collected and compared between the two groups.Logistic regression and multiple-factor analysis were performed to screen patients’risk factors for early postoperative complications,assess the effectiveness of related risk factors in predicting early postoperative complications,and propose targeted management strategies.Results:Compared with the non-complication group,patients in the complication group had a higher preoperative SCr level,a lower preoperative albumin level,more intraoperative bleeding,a shorter duration of postoperative intravenous antibiotics,and a higher proportion of diabetic patients(P<0.05).Multiple-factor logistic regression analysis showed that high preoperative SCr level,low preoperative albumin level,high intraoperative bleeding,and short duration of postoperative intravenous antibiotics were independent risk factors for the development of early postoperative complications in RARC patients(P<0.05).The AUC values of the prediction curves for preoperative SCr,preoperative albumin,intraoperative bleeding volume,and postoperative intravenous antibiotic using time were 0.851,0.789,0.742,and 0.823,respectively,suggesting that all of the above factors have a certain predictive value for the occurrence of early complications.Conclusion:High preoperative SCr level,low preoperative albumin level,high intraoperative bleeding,and short duration of postoperative intravenous antibiotics could all increase the risk of early postoperativ

关 键 词：根治性膀胱切除术 机器人辅助手术 早期并发症 危险因素 

分 类 号：R737.14[医药卫生—肿瘤]