腹腔镜肾上腺肿瘤切除术后并发症发生及住院时间延长的相关危险因素

Risk factors of perioperative complications and prolonged length of hospital stay in patients after laparoscopic adrenalectomy

目的:探究腹腔镜肾上腺肿瘤切除术后并发症发生及住院时间延长的相关危险因素。方法:回顾性分析北京医院2011年9月-2019年2月行腹腔镜肾上腺肿瘤切除术患者的临床病理资料,包括年龄、性别、身体质量指数(BMI)、美国麻醉医师协会(ASA)分级、既往合并症、腹部手术史、肿瘤大小和位置、病理类型、术后住院时间及术后并发症等相关指标。采用Dindo-Clavien分级标准对手术并发症的严重程度进行分级;单因素和多因素Logistic回归分析术后并发症发生及住院时间延长的独立危险因素。结果:共纳入206例患者,其中男88例,女118例;ASA≥3级者22例。所有患者均顺利完成手术,仅有5例患者术中由腹腔镜改行开放手术;中位肿瘤直径为3(2.0~3.5)cm。29例术后并发症Dindo-Clavien分级≥2级,并发症发生率为14.1%。53例术后住院时间>1周。多因素Logistic回归分析结果表明:ASA≥3级及肿瘤直径≥6 cm是术后并发症发生(OR=3.884,95%CI:1.218~12.386,P=0.022;OR=4.382,95%CI:1.106~17.371,P=0.035)及住院时间延长(OR=3.565,95%CI:1.239~10.258,P=0.018;OR=5.008,95%CI:1.378~18.194;P=0.014)的独立危险因素。结论:腹腔镜肾上腺肿瘤切除术具有较好的安全性,ASA≥3级、肿瘤直径≥6 cm是术后并发症发生及住院时间延长的独立危险因素。

Objective:To explore the risk factors of perioperative complications and prolonged length of hospital stay after laparoscopic adrenalectomyMethods:A retrospective analysis was conducted on patients who underwent laparoscopic adrenalectomy from September 2011 to February 2019 in Beijing Hospital.Clinical pathological data including patient’s age,gender,body mass index(BMI),American Society of Anesthesiologists(ASA)score,comorbidities,previous abdominal surgery,tumor size and tumor side,pathological changes,postoperative hospital stay and postoperative complications were collected in detail.The risk degree of complications were scored using the Dindo-Clavien classification system.Univariate and multivariate logistic regression was used to explore the independent risk factors associated with postoperative complications and prolonged hospital stay.Results:A total of 206 patients,including 88 males and 118 females were included.ASA score was≥3 grade in 22 patients.With the exception of 5 patients who were converted to open surgery,the rest patients successfully underwent laparoscopic surgery.The median tumor diameter was 3(2.0-3.5)cm.There were 29 patients with Dindo-clavien grade 2 or above,and the overall complication was reported in 14.1%of cases.Fifty-three patients were hospitalized for more than one week.Multivariate logistic regression analysis showed that ASA score≥3 and tumor diameter≥6 cm were independent risk factors for postoperative complications(OR=3.884,95%CI:1.218-12.386,P=0.022;OR=4.382,95%CI:1.106-17.371,P=0.035)and prolonged hospital stay(OR=3.565,95%CI:1.239-10.258,P=0.018;OR=5.008,95%CI:1.378-18.194;P=0.014).Conclusion:Laparoscopic adrenalectomy remains safe.ASA score≥3 and tumor diameter≥6 cm were independent risk factors for postoperative complications and prolonged hospital stay.