摘要
目的分析机器人辅助腹腔镜前列腺癌根治术(RARP)患者发生术后肠梗阻(POI)的危险因素。方法回顾性分析南京鼓楼医院2019年1至12月573例接受RARP患者的临床资料。根据术后肠梗阻发生情况,分为梗阻组和未梗阻组。比较两组患者的临床资料,采用多因素logistic回归分析探讨患者发生术后肠梗阻的独立危险因素。结果573例患者中45例(7.9%)发生了POI。两组患者术前基础疾病[心脏病、慢性阻塞性肺疾病(COPD)、低蛋白血症],术前化疗、术前白细胞、手术时间、出血量、输血率、术后早期发热、术后住院天数比较差异均有统计学意义(P<0.05)。多因素logistic回归分析示心脏病、COPD、低蛋白血症、出血量(≥4.26 ml/kg)、手术时间(≥225 min)、术后早期发热是影响RARP术患者发生POI的独立危险因素(OR=2.331、4.285、2.142、2.388、4.200、2.773,P=0.036、0.001、0.026、0.010、<0.001、0.004)。结论RARP患者POI的发生与围手术期多因素相关。改善术前心、肺功能,纠正低蛋白血症,减少术中出血,缩短手术时间,预防术后早期感染可能是降低RARP患者发生POI风险的重要措施。
Objective To analyze the risk factors of postoperative intestinal obstruction(POI)in patients undergoing robot-assisted laparoscopic radical prostatectomy(RARP).Methods The clinical data of 573 patients receiving RARP from January to December 2019 in Nanjing Drum Tower Hospital were analyzed retrospectively.According to the occurrence of POI,the cases were divided into the occurrence group and the non-occurrence group.The clinical data of the two groups were compared and the risk factors of POI were investigated by multivariate logistic regression.Results Forty-five of 573 patients(7.9%)had POI.Between the two groups,preoperative underlying diseases(cardiopathy,COPD,hypoalbuminemia),preoperative chemotherapy,preoperative WBC,operation time,blood loss,blood transfusion rate,postoperative early fever,length of stay were statistically significant(P<0.05).Multivariable logistic regression analysis showed that heart disease(OR=2.331,P=0.036),COPD(OR=4.285,P=0.001),hypoalbuminemia(OR=2.142,P=0.026),blood loss(≥4.26 ml/kg)(OR=2.388,P=0.010),operative time(≥225 min)(OR=4.200,P<0.001),and postoperative early fever(OR=2.773,P=0.004)were independent risk factors for POI after RARP.Conclusions The incidence of POI following RARP is related to multiple perioperative factors.Improving the preoperative heart and lung function,correcting hypoalbuminemia,reducing intraoperative bleeding,shortening the operation time,and preventing early postoperative infection may be important measures to reduce the risk of POI in RARP patients.
作者
崔士和
朱慧杰
马正良
Cui Shihe;Zhu Huijie;Ma Zhengliang(Department of Anesthesiology,Nanjing Drum Tower Hospital,Clinical College of Nanjing Medical University,Nanjing 210008,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2020年第34期2652-2657,共6页
National Medical Journal of China
基金
江苏省医学重点学科(XK201140)。
关键词
前列腺肿瘤
机器人辅助腹腔镜前列腺癌根治术
术后肠梗阻
危险因素
Prostatic neoplasm
Robot-assisted laparoscopic radical prostatectomy
Postoperative intestinal obstruction
Risk factors
