机器人辅助腹腔镜下膀胱癌根治术后早期并发症及其危险因素

目的：探索机器人辅助腹腔镜下膀胱癌根治术后早期并发症发生的危险因素，为预防术后早期并发症提供参考。方法：选择2016年1月至2018年1月在中南大学湘雅二医院和湘雅三医院行机器人辅助腹腔镜下膀胱癌根治术(robot-assisted laparoscopic radical cystectomy，RARC)的膀胱癌患者90例，收集患者基本信息、术前检查及术后90 d内随访资料。对术后早期并发症的危险因素行单因素和多因素logistic回归分析。结果：术后总体并发症发生率为48.9%(44/90)，其中Clavien分级1级9例，2级17例，3级4例，4级12例，5级2例。术后90 d内并发症以急性肾功能损伤(22.2%)、肠梗阻(16.7%)、尿路感染(14.4%)、淋巴漏(10.0%)最为常见。术后90 d内死亡2例(2.2%)。术前BMI(OR=1.16，95% CI：1.02~1.32)、术后30 min内血肌酐值(OR=1.02，95% CI：1.00~1.03)和pT分期(OR=1.67，95%CI：1.05~2.68)为RARC术后早期并发症的危险因素。结论：RARC术后早期并发症发生率较高，术前血液透析，纠正贫血，术中保护肾功能，快速康复治疗等有助于预防术后早期并发症的发生。

Early complications after robot-assisted laparoscopic radical cystectomy and their risk factors

Objective: To identify risk factors for early complications in patients after robot-assistedlaparoscopic radical cystectomy (RARC) and a standardized reporting model to predictcomplications precisely and recommend reasonable prophylaxis.Methods: A total of 90 patients with bladder cancer, who underwent RARC in the Second XiangyaHospital and the Third Xiangya Hospital of Central South University from January 2016 to January2018, were enrolled for this study. Their clinical information, preoperative examination and followupdata within 90 d after RARC were collected. Univariable and multivariable logistic regressionswere performed to identify risk factors for early complications after RARC.Results: The overall incidence of complications within 90 d after RARC was 48.9% (44/90),including 9 cases of Clavien grade 1, 17 cases of Clavien grade 2, 4 cases of Clavien grade 3, 12 casesof Clavien grade 4, and 2 cases of Clavien grade 5. Acute renal injury (22.2%), intestinal obstruction(16.7%), urinary tract infection (14.4%) and lymphatic leakage (10.0%) were the most commoncomplications within 90 d after the operation. Two patients (2.2%) died within 90 d after theoperation. Preoperative BMI (OR=1.16, 95% CI 1.02 to 1.32), postoperative instant (≤30 min)serum creatinine (OR=1.02, 95% CI 1.00 to 1.03), and pT stage (OR=1.67, 95% CI 1.05 to 2.68)were the risk factors for early complications after RARC.Conclusion: The incidence of early complications after RARC is high. Preoperative hemodialysis,correction of anemia, intraoperative protection of renal function, and early recovery after surgeryare helpful to prevent early complications after RARC.