高龄患者接受经尿道前列腺增生手术后围术期并发症的危险因素分析  

Risk Factors Analysis of Perioperative Complications in Elderly Patients Undergoing Transurethral Prostatectomy for Benign Prostatic Hyperplasia

作　　者：兰孝达 韩佳凝 姜瑞 车新艳 杨昆霖 左超 张骞[1] 肖云翔[1] 张凯[1] 孟一森[1] Lan Xiaoda;Han Jianing;Jiang Rui;Che Xinyan;Yang Kunlin;Zuo Chao;Zhang Qian;Xiao Yunxiang;Zhang Kai;Meng Yisen(Department of Urology,Peking University First Hospital,Beijing 100034,China;Department of Urology,Bei-jing Miyun District Hospital,Beijing 101500,China)

机构地区：[1]北京大学第一医院泌尿外科,北京100034 [2]北京市密云区医院泌尿外科,北京101500

出　　处：《微创泌尿外科杂志》2025年第1期38-45,共8页Journal of Minimally Invasive Urology

基　　金：国家重点研发计划重点专项资助(2022YFC3602902);中央高水平医院临床科研业务费资助(2023IR43,2023CX01);慢性病防治与健康教育科研项目资助(BJMB0012024026023)。

摘　　要：目的:分析高龄良性前列腺增生患者围术期并发症情况及其危险因素。方法:回顾性分析北京大学第一医院泌尿外科2013年1月至2023年1月接受经尿道前列腺增生手术的患者3597例,纳入年龄≥80岁的高龄患者430例(中位年龄82岁),其中接受经尿道前列腺电切术患者346例,经尿道激光前列腺剜除术患者84例。83例(19.3%)患者出现围术期并发症,347例(80.7%)患者无并发症发生。采用Clavien-Dindo分级统计围术期并发症的发生率、类型及严重程度;使用单因素和多因素Logistic分析探究围术期并发症及发生率较高的并发症的危险因素。结果:与无并发症的患者相比,出现围术期并发症的患者中位住院时间(3 d vs.4 d)和术后尿管中位拔除时间(4 d vs.6 d)明显延长(P均<0.001)。多因素回归分析示,切除组织重量(OR=1.011,95%CI:1.001~1.020,P=0.026)、糖尿病(OR=1.946,95%CI:1.096~3.455,P=0.023)及术前尿潴留(OR=1.784,95%CI:1.049~3.032,P=0.033)与高龄患者围术期并发症存在相关性。出血和感染是最常见的围术期并发症,多因素回归分析示,出血与手术方式(OR=0.207,95%CI:0.056~0.768,P=0.019)和切除组织重量(OR=1.031,95%CI:1.019~1.044,P<0.001)相关;术后感染与糖尿病(OR=2.624,95%CI:1.187~5.804,P=0.017)和手术时间(OR=1.011,95%CI:1.002~1.020,P=0.015)相关。根据Clavien-Dindo并发症分级:I级15例(3.5%),其中前列腺电切术11例,激光前列腺剜除术4例;II级61例(14.2%),其中接受前列腺电切术48例,接受激光前列腺剜除术13例;Ⅲ级及Ⅳ级7例(1.6%),均发生于前列腺电切术患者;未出现V级并发症。结论:切除组织重量、糖尿病、术前尿潴留和手术时间是高龄患者接受经尿道前列腺增生手术后发生围术期并发症的独立危险因素。对于高龄患者,经尿道激光前列腺剜除术的围术期Ⅲ、Ⅳ级严重并发症和出血相关并发症的发生率较低,该手术方式更适用于需手术治疗的高龄前列腺增�Objective:To investigate the perioperative complications and their associated risk factors in elderly patients with benign prostatic hyperplasia(BPH).Methods:A retrospective analysis was conducted on 3,597 pa-tients who underwent transurethral prostate surgery for BPH at the Department of Urology,Peking University First Hospital,between January 2013 and January 2023.Among them,430 patients aged≥80 years(median age 82 years)were included,consisting of 346 patients who underwent transurethral resection of the prostate(TURP)and 84 patients who underwent transurethral laser prostatectomy.Of these,83 patients(19.3%)developed perioperative complications,while 347 patients(80.7%)had no complication.The incidence,types,and severity of complications were classified using the Clavien-Dindo grading system.Univariate and multivariate Logistic regression analyses were performed to identify the risk factors for perioperative complications and those with a higher incidence.Results:Com-pared with patients without complications,those who experienced perioperative complications had significantly longer median hospital stays(3 days vs.4 days)and catheter removal times(4 days vs.6 days)(P<0.001).Multivariate re-gression analysis revealed that tissue resection weight(OR=1.011,95%CI:1.001–1.020,P=0.026),diabetes(OR=1.946,95%CI:1.096–3.455,P=0.023),and preoperative urinary retention(OR=1.784,95%CI1.049–3.032,P=0.033)were associated with perioperative complications in elderly patients.Bleeding and infection were the most common complications.Multivariate analysis showed that bleeding was associated with surgical method(OR=0.207,95%CI:0.056–0.768,P=0.019)and tissue resection weight(OR=1.031,95%CI:1.019–1.044,P<0.001),while postoperative infection was associated with diabetes(OR=2.624,95%CI:1.187–5.804,P=0.017)and surgi-cal duration(OR=1.011,95%CI:1.002–1.020,P=0.015).According to the Clavien-Dindo classification,15 pa-tients(3.5%)had grade I complications,including 11 TURP patients and 4 laser prostatectomy patients;61 pa

关 键 词：前列腺增生 经尿道前列腺切除术 激光剜除术 围术期并发症 高龄患者 

分 类 号：R699.8[医药卫生—泌尿科学]