经腹腔入路腹腔镜肾上腺手术患者术中肾周脂肪粘连的临床特征和相关预测因子分析  

Analysis of clinical features and related predictors of perirenal adipose adhesion in patients undergoing peritoneal approach laparoscopic adrenal surgery

作　　者：杨磊 辛在芳 杨兴忠 任东[1] 何礼涛[1] 李文林[1] 蒋绍博[2] Yang Lei;Xin Zaifang;Yang Xingzhong;Ren Dong;He Litao;Li Wenlin;Jiang Shaobo(Department of Urology,Rizhao Hospital of Traditional Chinese Medicine,Rizhao 276800,China;the First Department of Minimally invasive Urology of Shandong Provincial Hospital,Jinan 250021,China)

机构地区：[1]日照市中医医院泌尿外科,日照276800 [2]山东省立医院泌尿微创一科,济南250021

出　　处：《中国医师杂志》2025年第3期422-427,共6页Journal of Chinese Physician

摘　　要：目的探讨经腹腔入路腹腔镜肾上腺手术患者术中肾周脂肪粘连(APF)的临床特征,并分析其预测因子及危险因素,为临床诊治提供参考。方法回顾性选取2021年2月—2024年2月在日照市中医医院泌尿外科和山东省立医院泌尿微创一科接受经腹腔入路腹腔镜肾上腺手术治疗的86例患者作为研究对象,根据手术中患者是否发生APF将其分为APF组(29例),非APF组(57例),对比两组患者术前的肾周脂肪评分系统(MAP)评分、术前肾周脂肪CT检查密度值,并采用受试者工作特征(ROC)曲线分析各指标预测患者发生APF的价值,并采用单因素及多因素logistic回归模型分析患者发生APF的影响因素。结果APF组患者的MAP评分、肾周脂肪CT检查密度值(肾静脉水平、肾上腺肿瘤水平、正常肾上腺水平)、CT密度值评分均高于非APF组,差异均有统计学意义(均P<0.05);APF组的年龄、BMI、肾周脂肪厚度及合并糖尿病、高血脂占比均显著高于非APF组,差异均有统计学意义(均P<0.05)。MAP评分、肾周脂肪CT检查密度值(肾静脉水平、肾上腺肿瘤水平、正常肾上腺水平)、CT密度值评分预测腹腔镜肾上腺手术患者发生APF的ROC曲线下面积分别为0.921、0.655、0.628、0.538、0.912。Logistic回归模型结果显示:MAP评分高、CT密度值评分高、年龄大、BMI高、肾周脂肪厚度大、合并糖尿病是接受经腹腔入路腹腔镜肾上腺手术患者发生APF的独立危险因素(均P<0.05)。结论接受经腹腔入路腹腔镜肾上腺手术治疗的肾上腺肿瘤患者,术前采用MAP评分、CT肾周脂肪密度检查,有利于预测其是否发生APF,对手术方案的制定有一定的指导意义。ObjectiveTo investigate the clinical features of adherent perirenal fat(APF)in patients undergoing laparoscopic adrenal surgery through peritoneal approach,and to analyze its predictors and risk factors,so as to provide reference for clinical diagnosis and treatment.MethodsA total of 86 patients who received transabdominal approach laparoscopic adrenal surgery in the Department of Urology,the Rizhao Hospital of Traditional Chinese Medicine and the First Department of Minimally invasive Urology of Shandong Provincial Hospital from February 2021 to February 2024 were retrospectively selected as the study objects.According to whether patients developed APF during the operation,they were divided into APF group(29 cases)and non-APF group(57 cases).The Mayo Adhesive Probability(MAP)score and preoperative perirenal fat CT density were compared between the two groups.Receiver operating characteristic(ROC)curve was used to analyze the value of each index in predicting the occurrence of APF.Univariate and multivariate logistic regression models were used to analyze the influencing factors of the occurrence of APF.ResultsThe MAP score,CT density of perirenal fat(renal vein level,adrenal tumor level,normal adrenal gland level)and CT density score of the APF group were higher than those of the non-APF group,with statistical significance(all P<0.05).Age,body mass index(BMI),perirenal fat thickness and the proportion of diabetes mellitus and hyperlipidemia in the APF group were significantly higher than those in the non-APF group,with statistical significance(all P<0.05).The area under ROC curve predicted by MAP score,CT density of perirenal fat(renal vein level,adrenal tumor level,normal adrenal level)and CT density score for APF in patients undergoing laparoscopic adrenal surgery were 0.921,0.655,0.628,0.538,and 0.912,respectively.Logistic regression model results showed that high MAP score,high CT density score,old age,high BMI,large perirenal fat thickness,and complicated diabetes were independent risk factors for APF in pa

关 键 词：腹腔镜检查 肾上腺肿瘤 肾周脂肪粘连 

分 类 号：R699[医药卫生—泌尿科学]