后腹腔镜根治性肾切除术后并发症和住院时间延长的相关因素分析

目的探讨经腹膜后入路腹腔镜根治性肾切除术(laparoscopic radical nephrectomy，LRN)术后并发症和住院时间延长的相关因素。 方法回顾性分析北京安贞医院泌尿外科2010年8月至2021年8月期间，接受腹膜后入路LRN患者的临床资料，包括年龄、性别、体质量指数、合并症、美国麻醉医师协会(ASA)分级、既往腹部手术史、肿瘤大小、T分期、术中出血量、术中输血、术后并发症和术后住院时间等指标。采用Clavien-Dindo分级标准评价患者术后并发症情况，以术后住院时间的第75百分位数为分界点，术后住院时间>10 d定义为术后住院时间延长。应用单因素和多因素Logistic回归分析术后并发症和住院时间延长的危险因素。 结果本研究共纳入103例肾肿瘤患者，术后并发症Clavien-Dindo分级≥2级16例(15.5%)；住院时间延长(>10 d)17例(16.5%)。多因素Logistic回归结果显示：手术时间≥240 min (OR: 5.17, P＝0.024)和术中出血量>300 ml(OR: 22.89, P＝0.001)与术后并发症独立相关；术中输血(OR: 9.94, P＝0.023)是术后延迟出院的独立危险因素。 结论腹膜后入路LRN术后并发症和住院时间延长与术出血量，手术时间和术中是否输血等因素有关。

Factors associated with complications and prolonged hospital stay after retroperitoneal laparoscopic radical nephrectomy

ObjectiveTo explore the risk factors associated with postoperative complications and prolonged length of stay (LOS) following retroperitoneal laparoscopic radical nephrectomy (LRN). MethodsA retrospective data gathering from 103 patients in Beijing Anzhen hospital who underwent retroperitoneal LRN from Aug. 2010 to Aug. 2021 was conducted. The demographic and clinical data of the patients, including age, gender, Body Mass Index (BMI), comorbidities, American Society of Anesthesiologists (ASA) score, previous abdominal surgery, tumor size, T stage, intraoperative blood loss, intraoperative blood transfusions, postoperative complications and postoperative length of stay, were retrospectively collected. We examined the overall postoperative complications, which were categorized using the Dindo-Clavien classification system. A prolonged LOS was quantified in terms of postoperative hospital stay >10 days, which was defined as LOS >75th percentile of the dataset. Furthermore, univariate and multivariate logistic analysis were performed to identify the risk factor related to postoperative Clavien-Dindo complications and prolonged LOS. ResultsOverall, 103 participants participated in the study. A total of 16 cases (15.5%) suffered postoperative complications of Clavien-Dindo classification grade of 2 or more, and 17 cases (16.5%) had prolonged LOS. The risk factors associated with an increased prevalence of postoperative complications in a multivariate analysis were: operation time ≥240 minutes (OR: 5.17, P=0.024) and intraoperative blood loss >300 ml (OR: 22.89, P=0.001). Those associated with an increased prevalence of prolonged LOS was intraoperative blood transfusion (OR: 9.94, P=0.023). ConclusionsPostoperative complications and prolonged LOS following LRN were related to intraoperative blood loss, operative time, and intraoperative blood transfusion.