1993年至2005年2775例泌尿外科腹腔镜手术的并发症

Complications of 2,775 urological laparoscopic procedures: 1993 to 2005.

作者信息

Permpongkosol Sompol, Link Richard E, Su Li-Ming, Romero Frederico R, Bagga Herman S, Pavlovich Christian P, Jarrett Thomas W, Kavoussi Louis R

机构信息

Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.

出版信息

J Urol. 2007 Feb;177(2):580-5. doi: 10.1016/j.juro.2006.09.031.

DOI:10.1016/j.juro.2006.09.031

PMID:17222637

Abstract

PURPOSE

We assessed the complications associated with urological laparoscopic surgery at a single high volume center during a 12-year period.

MATERIALS AND METHODS

A retrospective chart analysis was performed, focusing on complications associated with 2,775 laparoscopic surgeries occurring between 1993 and 2005. These included radical nephrectomy (549), partial nephrectomy (345), donor nephrectomy (553), simple nephrectomy (186), pyeloplasty (301), nephroureterectomy (105), retroperitoneal lymph node dissection (86), renal ablation (81), adrenalectomy (106) and radical prostatectomy (463). Complication data were tabulated according to case number, procedure type, patient age, the American Society of Anesthesiologists score, conversion status, length of hospitalization, Clavien classification system and annual complication rate during the study. Statistical analysis was performed with Fisher's exact and chi-square tests.

RESULTS

A total of 614 complications (22.1%) occurred within each group, broken down into laparoscopic radical nephrectomy (20%), laparoscopic partial nephrectomy (28%), laparoscopic donor nephrectomy (28%), laparoscopic simple nephrectomy (15%), laparoscopic pyeloplasty (13.3%), laparoscopic nephroureterectomy (40.9%), laparoscopic retroperitoneal lymph node dissection (26.7%), laparoscopic renal tumor ablation (18.6%), laparoscopic adrenalectomy (25.4%) and laparoscopic radical prostatectomy (15%). Total intraoperative and postoperative complication rates were 4.7% and 17.5%, respectively. Vascular injuries were the most common intraoperative complications. Annual complication rates plateaued in the year 2000 and were not significantly different during the ensuing 4 years (p >0.05). Complications correlated with a greater American Society of Anesthesiologists score as well as a longer hospital stay (p <0.05).

CONCLUSIONS

The data presented here help define the complication rates for laparoscopic urological procedures in experienced hands at a high volume institution.

摘要

目的

我们评估了一家高手术量中心在12年期间泌尿外科腹腔镜手术相关的并发症。

材料与方法

进行了一项回顾性图表分析，重点关注1993年至2005年间发生的2775例腹腔镜手术相关的并发症。这些手术包括根治性肾切除术（549例）、部分肾切除术（345例）、供体肾切除术（553例）、单纯肾切除术（186例）、肾盂成形术（301例）、肾输尿管切除术（105例）、腹膜后淋巴结清扫术（86例）、肾肿瘤消融术（81例）、肾上腺切除术（106例）和根治性前列腺切除术（463例）。根据病例数、手术类型、患者年龄、美国麻醉医师协会评分、中转情况、住院时间、Clavien分类系统以及研究期间的年度并发症发生率，将并发症数据制成表格。采用Fisher精确检验和卡方检验进行统计分析。

结果

每组共发生614例并发症（22.1%），具体如下：腹腔镜根治性肾切除术（20%）、腹腔镜部分肾切除术（28%）、腹腔镜供体肾切除术（28%）、腹腔镜单纯肾切除术（15%）、腹腔镜肾盂成形术（13.3%）、腹腔镜肾输尿管切除术（40.9%）、腹腔镜腹膜后淋巴结清扫术（26.7%）、腹腔镜肾肿瘤消融术（18.6%）、腹腔镜肾上腺切除术（25.4%）和腹腔镜根治性前列腺切除术（15%）。术中及术后总并发症发生率分别为4.7%和17.5%。血管损伤是最常见的术中并发症。年度并发症发生率在2000年趋于平稳，在随后4年中无显著差异（p>0.05）。并发症与较高的美国麻醉医师协会评分以及较长的住院时间相关（p<0.05）。