Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
Urology. 2010 Feb;75(2):288-94. doi: 10.1016/j.urology.2009.09.036. Epub 2009 Dec 5.
To analyze our experience with laparoscopic partial nephrectomy (LPN) to detail postoperative adverse events and identify factors that may contribute to adverse surgical outcomes. Complications from LPN result from a variety of factors, both technical and inherent.
Single-center review of 144 consecutive LPN (4 surgeons) performed between November 2002 and January 2008 was conducted. Identified complications were graded using standard reporting criteria. Univariate and multivariate statistical analysis of variables and their association with complication event and blood loss was performed.
A total of 39 complications occurred in 29 (20%) cases. Of these, 20 (51%) were urologic and 19 (49%) were nonurologic. Individual adverse events by grade were as follows: grade I, 6 (15.4%); grade II, 19 (48.7%), grade III, 11 (28.2%), and grade IV, 3 (7.7%). No grade V complications occurred. The median tumor size and ischemia time were 2.7 cm and 35 minutes, respectively. Univariate analysis identified increased American Society of Anesthesiologists risk score (odds ratio 2.99, 95% confidence interval [CI] 1.28, 6.94) and ischemia time (odds ratio 1.31; 95% CI 1.00, 1.71) as associated with complication risk. On multivariate analysis, longer ischemia time was associated with increased estimated blood loss (95% CI 3, 57; P = .03). Hospital readmission and reintervention was required in 15 (10.4%) and 9 (6.2%) patients, respectively.
Complications from LPN occur in a meaningful proportion of procedures although the majority does not require reintervention and half are not urologic. Increasing ischemia time and American Society of Anesthesiologists score are associated with risk for unfavorable surgical outcomes.
分析我们在腹腔镜部分肾切除术 (LPN) 方面的经验，详细说明术后不良事件，并确定可能导致不良手术结果的因素。LPN 的并发症源于多种因素，包括技术因素和固有因素。
对 2002 年 11 月至 2008 年 1 月期间由 4 位外科医生完成的 144 例连续 LPN 进行单中心回顾。使用标准报告标准对已识别的并发症进行分级。对变量及其与并发症事件和出血量的关联进行单变量和多变量统计分析。
总共 29 例（20%）发生 39 种并发症。其中，20 种（51%）为泌尿科并发症，19 种（49%）为非泌尿科并发症。按等级划分的个别不良事件如下：1 级，6 例（15.4%）；2 级，19 例（48.7%）；3 级，11 例（28.2%）；4 级，3 例（7.7%）。未发生 5 级并发症。肿瘤大小和缺血时间中位数分别为 2.7 厘米和 35 分钟。单变量分析确定美国麻醉医师协会风险评分升高（优势比 2.99，95%置信区间 [CI] 1.28，6.94）和缺血时间（优势比 1.31；95% CI 1.00，1.71）与并发症风险相关。多变量分析显示，较长的缺血时间与估计出血量增加相关（95% CI 3，57；P =.03）。15 例（10.4%）和 9 例（6.2%）患者分别需要住院和再次干预。
尽管大多数并发症不需要再次干预，且半数以上不是泌尿科并发症，但 LPN 手术会发生一定比例的并发症。缺血时间和美国麻醉医师协会评分的增加与不良手术结果的风险相关。
