腹腔镜下全子宫切除术并发泌尿道损伤的相关因素分析

Analysis of the factors of urinary tract injury related to laparoscopic total hysterectomy

目的探讨腹腔镜下全子宫切除术并发泌尿道损伤的主要危险因素,为临床诊治提供参考。方法回顾性分析2010年1月至2018年10月在中国福利会国际和平妇幼保健院行腹腔镜下全子宫切除术2986例患者的临床资料,采集录入患者年龄、体质量指数(body mass index,BMI)、盆腔手术史、盆腔粘连程度(轻度,中度,重度)、子宫大小(子宫体积<10孕周、子宫体积≥10孕周)、手术时间、术中出血量、病变性质(良恶性),并通过Fox Pro建立数据库,应用SAS 6.12软件包,进行单因素与多因素分析。结果2986例腹腔镜下全子宫切除术患者中,共并发泌尿道损伤30例(1.00%),其中膀胱损伤22例(0.74%),输尿管损伤8例(0.27%)。单因素分析提示年龄、BMI、病变性质、出血量、手术时间、子宫体积≥10孕周、盆腔粘连程度是腹腔镜下全子宫切除术并发泌尿道损伤相关因素(P<0.05)。多因素分析提示腹腔镜下全子宫切除术并发泌尿道损伤与患者年龄、BMI、恶性病变、盆腔重度粘连、子宫体积≥10孕周呈正相关(P<0.05)。结论导致腹腔镜下全子宫切除术并发泌尿道损伤的危险因素较多,包括年龄、BMI、恶性病变、重度盆腔粘连、子宫体积≥10孕周5个方面,其中BMI、重度盆腔粘连、子宫体积≥10孕周之关系最为密切,应当从各方面综合预防。

Objective To investigate the risk factors of urinary tract injury related to laparoscopic total hysterectomy and provide a reference for clinical practice.Methods 2986 patients with laparoscopic hysterectomy were retrospectively analyzed from January 2010 to October 2018 at The International Peace Maternity&Child Health Hospital of China Welfare Institute y the research factors including age,body mass index(BMI),history of pelvic surgery,pelvic adhesion(light,moderate and severe pelvic adhesion),uterine size(uterine volume<10 gestational weeks,uterine volume^10 gestational weeks),operation time,intraoperative blood loss,disease feature(benign and malignant),database was established through FoxPro and SAS 6.12 software packages was used for univariate analysis and multivariate analysis.Results Among the 2986 cases of total laparoscopic hysterectomy,a total of 30 cases were complicated with urinary tract injury,with the complication rate of 1.00%,in which bladder injury of 22 cases with 0.74%,ureteral injury of 8 cases with 0.27%.Univariate analysis showed that age,BMI,disease feature,blood loss,operation time,uterine volume M10 gestational weeks,and the degree of pelvic adhesion,were factors of laparoscopic total hysterectomy complicated with urinary tract injury(P<0.05).Multivariate analysis showed that urinary tract injury complicated by laparoscopic total hysterectomy was positively correlated with age,BMI,malignant disease,severe adhesion and uterine volume10 gestational weeks(P<0.05).Conclusion The risk factors of laparoscopic total hysterectomy related urinary tract injury risk factors including age,BMI,malignant disease,severe adhesion and uterine volume M 10 gestational weeks,and BMI,severe pelvic adhesion and uterine volume 10 gestational weeks have the closest relations,which should be comprehensive prevention from all sides.