| 摘要: |
| 目的 分析和探讨后腹腔镜下肾部分切除术后发生尿瘘的危险因素。方法统计和分析2004-10-2013-06 行腹
腔镜下经后腹膜路径肾部分切除术后发生尿瘘的128 例肾肿瘤患者的临床资料，尿瘘严格定义为手术2d 后仍从后腹膜引流管持续引流出尿液。结果术后有14 例（10.9%）患者发生尿瘘。发生尿瘘的患者中10 例（71.4%）未行CTA 检查，术中平均出血量（232.3±86.7）ml，平均肾动脉阻断时间（28.2±7.5）min，平均住院时间（13.1±2.1）d，9 例（64.3%）术中发现集合系统破损。单因素分析提示年龄（P =0.1102）、糖尿病（P =0.0445）、肿瘤内生型生长（P =0.0835）、术前是否行CTA 检查（P=0.0137）、集合系统损伤（P=0.0935）、肾动脉阻断时间（P =0.1225）及术中出血量（P=0.0045）是发生尿瘘的危险因素；多因素分析提示糖尿病（P =0.0381）、术前是否行CTA 检查（P =0.0433）及术中出血量（P =0.0155）是术后发生尿瘘的独立危险因素。结论糖尿病、术中出血
量及术前是否行肾脏CTA 检查是后腹腔镜下肾部分切除术后发生尿瘘的独立危险因素。减少术中出血有利于术者获得清晰的操作视野，有效缝合破损的集合系统，从而防止尿瘘的发生。 |
| 关键词: 肾肿瘤 腹腔镜 肾部切 并发症 尿瘘 |
| DOI： |
| 分类号: |
| 基金项目: |
|
| Risk factors for urine leaks after retroperitoneal laparoscopic partial nephrectomy |
|
WU Jiabo,XIA Dan,CHEN Bing
|
|
Zhoushan Hospital,Affiliated to Wenzhou Medical University
|
| Abstract: |
| Objective To investigate the risk factors associated with urine leaks after retroperitoneal laparoscopic partial nephrectomy (LPN). Methods One hundred and twenty eight patients with renal tumors underwent retroperitoneal laparoscopic partial nephrectomy from October 2004 to June 2013. Urine leak was defined as continuing urine drein from retroperitoneal drainage-tube after postoperative day 2. Results In our series, 14 patients (11%) had urine leaks after postoperative day 2. Among patients with urine leaks, 10 (71.4%) refused to take a CT angiogram (CTA) examination, 9 had collecting-system injury during operation. The mean intraoperative blood loss was (232.3±86.7)ml, mean ischemia time was (28.2±7.5)min, and mean average length of hospital stay was (13.1±2.1)d. Univariate analysis showed that age (P=0.1102), diabetes mellitus (P=0.0445), endophytic growth of tumor(P=0.0835), no preoperative CTA examination(P=0.0137), collecting-system injury(P=0.0935),ischemia time (P=0.1225), intraoperative blood loss (P=0.0045) were associated with urine leaks. Multivariate analysis indicated that diabetes mellitus(P=0.0381), no preoperative CTA examination (P=0.0433), and intraoperative blood loss(P=0.0155) were independent risk factors for urine leaks. Conclusion The results indicate that diabetic disease, intraoperative blood loss and no
preoperative CTA examination are predictors for urine leaks after retroperitoneal laparoscopic nephrectomy. |
| Key words: Renal carcinoma Laparoscopy Nephron-sparing Urine leak Complications |
