上午和下午手术对择期行机器人辅助腹腔镜下前列腺癌根治术的老年病人围术期并发症的影响

Effect of morning and afternoon surgery on perioperative complication in elderly patients undergoing elective robot-assisted laparoscopic radical prostatectomy

目的探讨不同时间段进行手术对老年病人围术期并发症和住院时长的影响。方法选择2018年4月至2021年6月在南京大学医学院附属鼓楼医院择期行机器人辅助腹腔镜下前列腺癌根治术(RARP)的老年病人358例,收集术前一般临床资料及术后并发症发生情况。根据手术开始时间,以12:00为界限,分为上午组141例及下午组217例。比较2组病人术前一般临床资料及术中和术后并发症的发生情况。结果2组病人术前一般临床资料差异无统计学意义(P>0.05)。上午组术中血糖水平和高血糖发生率明显高于下午组(P<0.05)。此外,上午组术中失血量也明显高于下午组(P<0.05)。2组术后急性肾损伤(AKI)的发生率无明显差别,但是上午组术后肌酐水平明显高于下午组(P<0.05),而肾小球滤过率明显低于下午组(P<0.05)。此外,上午组白细胞计数、中性粒细胞计数、单核细胞计数及C反应蛋白水平明显高于下午组(P<0.05)。2组术后尿素氮水平、术后感染率、其他并发症发生率和住院时长差异无统计学意义(P>0.05)。结论在本研究条件下,老年病人下午择期行RARP术可以降低术中高血糖的发生、减少术中失血、保护肾脏功能并缓解免疫反应。但是,手术开始时间对住院时长没有明显的影响。

Objective To investigate the effect of different time points of operation on perioperative complications and length of hospital stays in the elderly patients undergoing robot-assisted laparoscopic radical prostatectomy(RARP).Methods In this study,358 elderly patients who underwent elective RARP surgery in Nanjing Drum Tower Hospital from April 2018 to June 2021 were divided into the morning group and the afternoon group according to whether the starting time of the operation was before 12:00.There were 141 cases in the morning group and 217 cases in the afternoon group.The differences in the preoperative general clinical data and the incidence of intraoperative and postoperative complications were compared between the two groups.Results There were no significant differences in preoperative clinical data between the two groups(P>0.05).Intraoperative blood glucose levels,incidence rate of hyperglycemia and intraoperative blood loss were significantly higher in the morning group than those in the afternoon group(P<0.05).The incidence rate of postoperative acute kidney injury(AKI)showed no significant difference between the two groups.While the level of creatinine was significantly higher and the glomerular filtration rate was significantly lower in the morning group than that in the afternoon group(P<0.05).Furthermore,there was no significant difference in the postoperative urea nitrogen level,postoperative infection rate,the incidence rate of other complications and the length of hospital stays between the two groups(P>0.05).However,the levels of white blood cell count,Neutrophil count,Monocyte count and C-reactive protein level in the morning group were higher than those in the afternoon group(P<0.05).Conclusions Under the conditions of this study,the elderly patients undergoing RARP in the afternoon were more likely to reduce the occurrence of intraoperative hyperglycemia and intraoperative blood loss,protect kidney function and alleviate immune response.However,the starting time of surgery has no significant effect on the incidence of other complications and length of hospital stay.