经腹腔后入路腹腔镜肾上腺切除术手术时间延长的危险因素分析

Risk factors analysis for prolonged operation time in retroperitoneal laparoscopic adrenalectomy

目的探讨经腹膜后入路腹腔镜肾上腺切除术(RLA)手术时间延长的危险因素。方法回顾性分析2016年1月-2021年12月该院泌尿外科收治的420例因肾上腺病变行RLA手术的患者的临床资料,包括:年龄、性别、体重指数(BMI)、合并症、既往腹部手术史、手术时间、瘤体大小、术后病理类型和肿瘤位置等。以手术时间的第75百分位数(140 min)为分界点,手术时间超过140 min的,定义为手术时间延长。分别应用单因素和多因素Logistic回归模型,分析引起RLA手术时间延长的危险因素,计算受试者操作特征曲线(ROC curve)的曲线下面积(AUC),分析相关因素对RLA手术时间延长的预测价值。结果96例(22.86%)出现手术时间延长。单因素Logistic回归分析结果显示,男性、BMI≥31 kg/m2、术者经验(≤30例)、手术方式(肾上腺全切)、瘤体直径≥3.6 cm、病理类型(肾上腺皮质增生和嗜铬细胞瘤),与RLA手术时间延长有关。多因素Logistic回归分析结果显示,男性、BMI≥31 kg/m2、术者经验(≤30例)、瘤体直径≥3.6 cm和嗜铬细胞瘤,是引起RLA手术时间延长的独立危险因素。以病理类型(嗜铬细胞瘤)、性别(男性)、术者经验(≤30例)、BMI≥31 kg/m2和瘤体直径≥3.6 cm为预测因素,AUC为0.735(95%CI:0.678~0.793)。结论RLA手术时间延长与性别、BMI、病理类型、术者经验和瘤体直径等因素有关,术前对这些危险因素进行识别,有助于更准确地选择手术方案,缩短手术时间。

Objective To explore the risk factors associated with prolonged operation time in retroperitoneal laparoscopic adrenalectomy(RLA).Methods A retrospective research was conducted with data gathered from 420 cases who underwent RLA for adrenal lesions from Jan 2016 to Dec 2021.Demographic and hospital admission data were collected from these patients,including sex,age,body mass index(BMI),preoperative comorbidities,history of previous abdominal surgery,operative time,lesion diameter,postoperative pathology,tumor lateralization and so on.Patients were separated into two groups according to the operative time,using the 75th percentiles(140 min)as the cut-off point.Furthermore,the univariate and multivariate Logistic analysis were employed to determine the risk factors related to prolong operation time.The receiver operator characteristic curve(ROC curve)was plotted and the area under the curve(AUC)calculated to explore the predictive value of the risk factors.Results Across all patients,96(22.86%)referred to prolonged operation time.Results from univariate Logistic regression proved that male,BMI≥31 kg/m2,pheochromocytoma,adrenal cortical hyperplasia,surgeon experience(≤30),tumor diameter≥3.6 cm,and surgical method(total resection)were associated with prolonged operation time in RLA.The multivariate Logistic regression indicated that male,BMI≥31 kg/m2,pheochromocytoma,surgeon experience≤30,and tumor diameter≥3.6 cm were independent risk factors for RLA.AUC was 0.735(95%CI:0.678~0.793)in the multivariate Logistic regression model for predicting prolonged operation time.Conclusion BMI,tumor size,pathology,surgical procedure and gender were associated with the increased risk of prolong operation time in RLA.These findings contribute essential information for the planning and development of a better treatment protocol for patients undergoing RLA.