后腹腔镜根治性肾切除与肾部分切除中转开放的危险因素分析

摘要

Objective To evaluate the risk factors of conversion to open management during laparoscopic total nephrectomy ( LTN) and laparoscopic partial nephrectomy ( LPN). Methods We collected the patients underwent LTN and LPN in our center during the last 3 years, according to conversion to open management or not, we divided the patients in converted group and non-converted group, single factor analysis was performed with age, gender, body mass index (BMI) , cardiovascular disease, diabetes, previous abdominal surgery, diameter and position of tumor, then the logistic regression was performed in those variables with statistical difference, and evaluated which was the independent risk factor. Results A total of 118 patients were enrolled. There were statistical difference in age, BMI, cardiovascular disease, diabetes, previous abdominal surgery, diameter and position of tumor. After logistic regression procedure, we found that BMI and previous abdominal surgery could be treated as the independent risk factor for LTN and LPN. Diameter and position of tumor also had great influence on LPN. Non-converted group was superior than converted group in operation time [ (92.69 ± 19.43) min vs ( 104.90 ±21.97) min, t = -2.24, P=0.03], intra-operative blood loss [ (71.12 ± 19.31) mL vs (87.03 ± 34.65 ) mL, ( = -7.52, P = 0.003) and hospital stay [(4.46 ±1.53) d vs (5.47 ± 0.92) d, ( = -2.49, P = 0.0l). Conclusions LTN and LPN is safe and effective management for renal disease but there are technically requirements. Obesity patients who have previous abdominal surgery, as well as tumor diameter large than 6 cm and locate in the lower pole of kidney, have more opportunities of conversion to open surgery, and should be given a systematic evaluation before surgical management.%目的 探讨后腹腔镜根治性肾切除与肾部分切除中转开放的相关危险因素,以进一步指导临床实践.方法 选取云南省第一人民医院泌尿外科近3a行后腹腔镜根治性肾切除与肾部分切除的118例患者,按是否有中转开放分为中转组和非中转组,对可能存在影响的指标(性别、年龄、身高、体重、高血压史、糖尿病史、腹部手术史、肿瘤直径、切除方式及肿瘤位置)行单因素分析及logistic回归,拟找出相关危险因素或独立危险因素.结果 经单因素分析显示中转组和非中转组年龄、BMI、高血压病史、血脂异常、糖尿病、腹部手术史、肿瘤直径及肿瘤位置差异有统计学意义,进一步对上述因素进行logistic回归分析发现BMI＞ 24 kg/m2及腹部手术史是两种术式的独立危险因素,其余所纳入模型的因素亦有影响.肿瘤直径＞6cm及肿瘤位置位于下极是后腹腔镜肾部分切除的独立危险因素.且中转组相对于非中转组手术时间更长[(92.69±19.43) min vs (104.90± 21.97)min,t=-2.24,P=0.03],术中出血多[(71.12±19.31mL) vs (87.03±34.65) mL,t=-7.52,P=0.003]和术后住院天数长[(4.46±1.53)d vs (5.47±0.92)d,t=-2.49,P=0.01].结论 对于肥胖、有腹部手术史、及肿瘤直径较大且位于肾下极的患者行后腹腔镜根治性肾切除与部分切除其中转开放的机率显著增加,对此类患者有必要术前进行系统评估.