泌尿外科老年患者腹腔镜术后常见并发症及危险因素分析

Common postoperative complications and risk factors in elderly patients treated with laparoscopic urological surgery

目的分析泌尿外科老年患者腹腔镜手术常见的并发症及可能的危险因素,为提高手术疗效及减少术后并发症提供依据。方法收集本院2012年10月至2014年10月于本院泌尿外科进行腹腔镜手术的老年患者500例,收集患者临床资料及手术后病例记录,分析患者相关术后并发症,如切口感染、尿路感染、腹腔感染、术后出血、尿潴留、吻合口漏、胸膜损伤、腹膜损伤、结肠损伤、腹膜后血肿、腹主动脉损伤和高碳酸症等。比较各并发症发生频率并采用Clavien-dindo评分系统进行分级;随后采用多元线性Logistic回归对患者性别、年龄、腹部手术史、糖尿病、肺部疾病、心脏疾病、手术时间、出血量、术中并发症、中转开腹、预防性造口、血红蛋白等可能导致腹腔镜术后并发症的原因进行分析。结果本组500例实施腹腔镜手术病例发生术后并发症120例,其中,肾囊肿去顶减压术28例,术后并发症发生率最高(5.6%),其次为肾上腺腺瘤摘除术21例(4.2%),肾包膜部分切除加大网膜包裹术、输尿管松解术、肾蒂淋巴管剥脱术各2例(0.4%)。根据单因素分析结果,将糖尿病(P=0.009)、手术时间(P=0.012)、出血量(P=0.006)、术中并发症(P=0.011)纳入多元素分析,多因素Logistic回归分析,影响术后并发症危险因素大小依次为糖尿病、手术时间、术中出血量和术中并发症。结论泌尿外科老年患者常见的术后并发症为切口感染、术后出血和腹膜损伤。糖尿病、手术时间、术中出血量和术中并发症可能是造成术后并发症的危险因素。

Objective To analyze the common complications and risk factors in elderly patients after laparoscopic urological surgery.Methods The clinical data of 500 elderly patients treated with laparoscopic urological surgery during Oct.2012 and Oct.2014 were collected to analyze the common postoperative complications,including incision infection,urinary tract infection,abdominal cavity infection,postoperative bleeding,urinary retention,anastigmatic leakage,pleural damage,peritoneal injury,colon injury,retroperitoneal hematoma,abdominal aorta injuries,high carbonate and others.The incidence of complications were analyzed and classified by Clavien-dindo score system.Then the linear multivariate between the incidence of complications and the risk factors were analyzed by logistic regression,including gender,age,history of abdominal surgery,history of diabetes,lung disease,heart disease,operation time,blood loss,intraoperative complications and transference to laparotomy,preventive colostomy and hemoglobin.Results Of all cases,120 developed postoperative complications,among which28 cases of renal cyst unroofing decompression had the highest incidence of postoperative complications（5.6%）,followed by 21 cases of adrenal adenoma excision（4.2%）,and 2 cases of renal capsule partial removal of the greater omentum package（0.4%）,2 cases of ureteral release（0.4%）,and2 cases of renal pedicle lymphatic vessels（0.4%）.According to the results of single factor analysis,the following risk factors,namely diabetes（P=0.009）,operation time（P=0.012）,bleeding（P=0.006）,intraoperative complications（P=0.011）were included in the multiple factors Logistic regression analysis,which showed the risk factors for postoperative complications included diabetes,operation time,intraoperative blood loss and intraoperative complications.Conclusions Infection of incision,postoperative bleeding and peritoneal injury are the most common postoperative complications for elderly patients treated with urological surgery.Diabetes,operation time,intraoperative blood loss and intraoperative complications may be the risk factors of postoperative complications.