局限性肾癌患者腹腔镜下肾部分切除术后发生深静脉血栓形成的危险因素分析

Analysis of risk factors of deep vein thrombosis after laparoscopic partial nephrectomy in localized renal cell carcinoma patients

目的探讨局限性肾癌患者腹腔镜下肾部分切除术后发生深静脉血栓形成的危险因素。方法回顾性分析2018年6月至2021年6月于山东第一医科大学附属省立医院泌尿外科接受腹腔镜下肾部分切除术治疗的150例局限性肾癌患者的临床资料,根据术后是否发生深静脉血栓形成将患者分为病例组和对照组,对比两组患者的性别、年龄、手术时间等临床资料,并进行单因素分析;将组间比较有显著差异的单因素代入二元Logistic回归分析模型,筛选出局限性肾癌患者腹腔镜下肾部分切除术后发生深静脉血栓形成的独立危险因素;绘制受试者工作特征(ROC)曲线验证上述危险因素预测的准确性。结果两组患者的年龄、性别、手术入路、手术时间、气腹压力、留置引流管时间、尿微量白蛋白、尿素氮、总胆固醇、超敏C反应蛋白水平差异有统计学意义(P<0.05);Logistic回归分析显示,总胆固醇水平、手术时间、气腹压力、留置引流管时间是局限性肾癌患者腹腔镜下肾部分切除术后发生深静脉血栓形成的独立危险因素。ROC曲线分析结果表明,手术时间、总胆固醇水平、留置引流管时间、气腹压力、手术入路预测局限性肾癌患者腹腔镜下肾部分切除术后发生深静脉血栓形成的曲线下面积分别为0.821、0.735、0.692、0.612、0.570,敏感度分别为56%、68%、30%、94%、78%,特异度分别为93%、70%、100%、34%、8%,约登指数分别为0.490、0.380、0.300、0.280、0.140。结论手术时间、总胆固醇水平、留置引流管时间、气腹压力和手术入路是局限性肾癌患者腹腔镜下肾部分切除术后发生深静脉血栓形成的独立危险因素,手术时间、总胆固醇水平的预测准确性较好。

Objective To investigate the risk factors of deep vein thrombosis(DVT)after laparoscopic partial nephrectomy(LPN)in localized renal cell carcinoma patients.Methods The clinical data of 150 localized renal cell carcinoma(LRCC)patients receiving LPN in Department of Urology,Shandong Provincial Hospital Affiliated to Shandong First Medical University during Jun.2018 to Jun.2021 were retrospectively analyzed.The patients were divided into case group and control group according to the occurrence of DVT.The clinical data of the two groups,such as gender,age,surgery duration were compared and analyzed in a single-factor analysis.The factors with significant differences between two groups were substituted into binary logistic regression analysis for independent risk factor test.The receiver operator characteristic curve was drawn to further verify the accuracy of the above factors.Results Age,gender,surgical approach,surgery duration,pneumoperitoneum pressure,duration of drainage tube indwelling,blood urea nitrogen,urinary microalbumin,hypersensitive C-reactive protein and total cholesterol levels showed statistically significant differences between two groups(P<0.05).Logistic regression showed that surgery duration,pneumoperitoneum pressure,duration of drainage tube indwelling and total cholesterol level were the independent risk factors of occurrence of DVT in LRCC patients after LPN.Receiver operator characteristic curve analysis of the accuracy verifying showed that the areas of surgery duration,total cholesterol level,duration of drainage tube indwelling,pneumoperitoneum pressure and surgical approach under the curve were 0.821,0.735,0.692,0.612,0.570.The sensitivity of the above factors were 56%,68%,30%,94%,78%and the specificity were 93%,70%,100%,34%,8%.The Youden index were 0.490,0.380,0.300,0.280 and 0.140.Conclusions Surgery duration,total cholesterol level,duration of drainage tube indwelling,pneumoperitoneum pressure and surgical approach were the independent risk factors of occurrence of DVT in LRCC patients after LPN.The accuracy of surgery duration and total cholesterol level were better.