手助腹腔镜下活体供肾切取手术时间的影响因素及其与术后并发症的关系分析

宋泓辰; 吕竟成; 郭宇文; 张健; 王志鹏; 朱一辰

doi:10.3969/j.issn.1674-7445.2023211

手助腹腔镜下活体供肾切取手术时间的影响因素及其与术后并发症的关系分析

doi: 10.3969/j.issn.1674-7445.2023211

100050　北京，首都医科大学附属北京友谊医院泌尿外科

基金项目: 北京市医管中心培育计划（PX2023002）

详细信息

作者简介:

通讯作者:
朱一辰（ORCID 0000-0002-6966-8709），博士，主任医师，研究方向为泌尿外科，Email：yczhu@ccmu.edu.cn

中图分类号: R617, R692
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- 被引次数: 0
出版历程
- 收稿日期: 2023-10-14
- 录用日期: 2023-12-13
- 网络出版日期: 2023-12-25
- 刊出日期: 2024-03-15

Relationship between influencing factors of operation time and postoperative complications in hand-assisted laparoscopic living donor nephrectomy

Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China

More Information

Corresponding author: Zhu Yichen，Email: yczhu@ccmu.edu.cn

摘要

摘要: 目的探究手助腹腔镜下活体供肾切取手术时间的影响因素，并探究其与术后并发症严重程度间的关系。方法回顾性分析91例行手助腹腔镜下活体供肾切取术的供者的临床资料，分析供者术前基线资料与手术时间之间的相关性，研究手术时间与术后并发症的关系并确定手术时间的阈值。结果肾动脉数量多、肾周脂肪及肾脏后侧脂肪较厚、罹患代谢综合征、梅奥粘连概率（MAP）评分及Clavien-Dindo评分较高均会导致手术时间延长。通过分析受试者工作特征（ROC）曲线发现，当手术时间≥138 min时，供者术后并发症的发生率显著升高（P<0.05）。结论对于具有多支肾动脉、肾周及肾脏后侧脂肪厚度较厚、罹患代谢综合征、MAP评分及Clavien-Dindo评分较高的供者，可选择手术经验更为丰富的医师，做好充分的术前准备并在术后予以密切关注，以及时发现术后并发症并降低并发症的严重程度，改善供者预后。
- 手助腹腔镜 /
- 活体供者 /
- 肾切除术 /
- 梅奥粘连概率评分 /
- Clavien-Dindo评分 /
- 受试者工作特征（ROC） /
- 脂肪厚度 /
- 代谢综合征
Abstract: Objective To identify the influencing factors of operation time of hand-assisted laparoscopic living donor nephrectomy, and to analyze the relationship between influencing factors and the severity of postoperative complications. Methods Clinical data of 91 donors who underwent hand-assisted laparoscopic nephrectomy were retrospectively analyzed. The correlation between preoperative baseline data of donors and operation time was analyzed. The relationship between operation time and postoperative complications was assessed and the threshold of operation time was determined. Results Multiple donor renal arteries, thick perirenal and posterior renal fat, metabolic syndrome, high Mayo adhesive probability (MAP) score and Clavien-Dindo score prolonged the operation time. By analyzing the receiver operating characteristic (ROC) curve, we found that when the operation time was ≥138 min, the incidence of postoperative complications of donors was significantly increased (P<0.05). Conclusions For donors with multiple renal arteries, thick perirenal and posterior renal fat, metabolic syndrome and high MAP score and Clavien-Dindo score, experienced surgeons should be selected to make adequate preoperative preparation and pay close attention after surgery, so as to timely detect postoperative complications and reduce the severity of complications, enhance clinical prognosis of the donors.
- Hand-assisted laparoscopy /
- Living donor /
- Nephrectomy /
- Mayo adhesive probability score /
- Clavien-Dindo score /
- Receiver operating characteristic (ROC) /
- Fat thickness /
- Metabolic syndrome

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图 1 肾周脂肪厚度、肾后脂肪厚度及腹主动脉钙化测量示意图

注：A图为肾周脂肪厚度、肾脏后侧脂肪厚度测量示意图；B图为腹主动脉钙化测量示意图。RV为肾静脉；L为肾周脂肪厚度；R为肾脏后侧脂肪厚度。

Figure 1. Schematic diagram of measurement of perirenal fat thickness, postrenal fat thickness and abdominal aortic calcification

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图 2 手术时间预测术后并发症的ROC曲线

Figure 2. ROC curve of postoperative complications predicted by operation time

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表 1 供者术前基线资料对手术时间的影响分析

Table 1. Analysis of the influence of preoperative baseline data of donors on operation time

变量	n	数值	相关系数	P值
年龄[M（P₂₅, P₇₅），岁]	91	53（50，57）	0.012	0.909^rs
男性[n（%）]	91	29（32）	−0.018	0.264^rs
BMI（$ \stackrel{-}{\mathit{x}}\pm \mathit{s} $，kg/m²）	91	24.4±2.8	0.039	0.716^r
美国麻醉医师协会分级[n（%）]	91		0.710	0.945^rs
Ⅰ级		20（22）
Ⅱ级		70（77）
Ⅲ级		1（1）
吸烟史[n（%）]	91	20（22）	−0.743	0.458^rs
高血压史[n（%）]	91	13（14）	0.140	0.183^rs
心血管疾病史[n（%）]	91	4（4）	−0.015	0.483^rs
总胆固醇（$ \stackrel{-}{\mathit{x}}\pm \mathit{s} $，mmol/L）	91	4.6±1.0	−0.109	0.314^r
甘油三酯[M（P₂₅, P₇₅），mmol/L]	91	1.3（0.9，1.7）	0.084	0.435^rs
代谢综合征[n（%）]	91	10（11）	0.235	0.027^rs
术前血清肌酐（$ \stackrel{-}{\mathit{x}}\pm \mathit{s} $，μmol/L）	91	63±11	0.204	0.053^r
供肾长度[M（P₂₅, P₇₅），cm]	91	11.0（10.0，11.5）	0.136	0.203^rs
供肾体积[M（P₂₅, P₇₅），cm³]	91	141.7（125.4，166.4）	0.020	0.854^rs
肾动脉数量[n（%）]	91		9.537	0.002^rs
1		76（84）
2		14（15）
3		1（1）
皮下脂肪厚度（$ \stackrel{-}{\mathit{x}}\pm \mathit{s} $，cm）	91	2.3±0.8	−0.054	0.634^r
肾周脂肪厚度[M（P₂₅, P₇₅），cm]	91	1.0（0.7，1.6）	0.328	0.002^rs
肾脏前侧脂肪厚度[M（P₂₅, P₇₅），cm]	91	0.5（0.3，0.8）	0.118	0.286^rs
肾脏后侧脂肪厚度[M（P₂₅, P₇₅），cm]	91	0.7（0.3，1.1）	0.216	0.049^rs
MAP评分[n（%）]	91		12.870	0.029^rs
0		64（70）
1		23（25）
2		2（2）
3		0
4		2（2）
腹主动脉钙化[n（%）]	91	16（18）	0.067	0.545^rs
Clavien-Dindo评分[n（%）]	91		0.269	0.010^rs
0		82（90）
1		2（2）
2		5（5）
3		1（1）
4		1（1）
注：当相关系数为正值时，因变量越大，手术时间越长；相反，当相关系数为负值时，因变量越大，手术时间越短。^r表示采用Pearson相关性检验，^rs表示采用Spearman相关性检验。

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