老年局限性肾癌患者腹腔镜肾部分切除术后发生肺栓塞的危险因素分析

Analysis of risk factors for pulmonary embolism in elderly patients with localized renal cell carcinoma after laparoscopic par-tial nephrectomy

中文关键词: 老年, 腹腔镜肾部分切除术, 局限性肾癌, 肺栓塞

英文关键词: elderly  laparoscopic partial nephrectomy  localized renal cell carcinoma  pulmonary embolism

中文摘要:

      目的 分析老年局限性肾癌患者腹腔镜肾部分切除术(RLPN)后发生肺栓塞(PE)的危险因素.方法 选取2022年8月-2024年1月江苏省人民医院收治的140例老年局限性肾癌(LRCC)行RLPN手术的患者,根据是否发生PE分为发生PE组(n=90)和未发生PE组(n=50).采用单因素和多因素方法分析RLPN手术后发生PE的相关危险因素,并建立风险预测模型.结果 单因素分析显示,患者BMI指数、慢性心血管疾病(高血压、冠心病)、年龄、TC、手术时间、气腹时间、术后卧床时间、是否使用间歇充气加压装置等均与LRCC患者行RLPN术后发生PE有关(P＜0.05).Lo-gistic 回归分析显示,年龄≥75岁、BMI指数、手术时间、气腹压力、术后卧床时间＞3 d、TC、是否使用间歇充气加压装置等均为导致LRCC患者RLPN术后发生PE的独立危险因素(P＜0.05).将上述7个变量纳入构建预测模型,最终得到公式为:Logit(P)=-32.180+1.764 × 年龄≥75 岁+2.431 × BMI 指数(kg/m2)+0.095 × 手术时间(min)+0.656 × 气腹压力(mmHg)+1.227 ×术后卧床时间＞3 d+1.130 × TC(mmol/L)+1.093 ×间歇充气加压装置(是=0,否=1).该模型预测LRCC患者RLPN术后发生PE风险的ROC曲线下面积AUC为0.787(95％CI:0.724～0.816),约登指数为1.460 2,灵敏度0.64,特异度为0.62.Hosmer-Lemeshow拟合优度检验显示,该模型具有良好的校准度(x2=8.093,P=0.421 7).结论 老年LRCC患者行RLPN术后易发生PE,这可能与年龄、BMI指数、手术时间、手术入路、气腹压力、术后卧床时间、TC、是否使用间歇充气加压装置相关.

英文摘要:

      Objective To analyze the risk factors for pulmonary embolism(PE)in elderly patients with localized renal cancer(LRCC)after laparoscopic partial nephrectomy(RLPN).Methods 140 elderly LRCC patients who underwent RLPN in People's Hospital of Jiangsu Province from August 2022 to January 2024 were selected and divided into PE group(n=90)and non-PE group(n=50)according to whether PE occurred.The univariate and multivariate analysis were used to analyze the relevant risk factors for PE after RLPN,and a risk prediction model was established.Results Univariate analysis showed that BMI,chronic cardiovascular disease(hypertension,coronary heart disease),age,TC,surgery time,pneumoperitoneum time,postoperative bed rest time,and use of intermittent inflation pressure devices were all related to the occurrence of PE in LRCC patients after RLPN(P＜0.05).Logistic regression analysis showed that age ≥ 75 years,BMI,surgery time,pneumo-peritoneum pressure,postoperative bed rest time＞3 d,TC and the use of intermittent inflation pressure devices were all inde-pendent risk factors for PE in LRCC patients after RLPN(P＜0.05).The above 7 variables were included in the construction of a prediction model,and the final formula was:Logit(P)=-32.180+1.764 × age≥75 years+2.431 × BMI index(kg/m2)+0.095 × surgery time(min)+0.656 × pneumoperitoneum pressure(mmHg)+1.227 × postoperative bed rest time＞3 d+1.130 × TC(mmol/L)+1.093 × intermittent inflation pressure device(yes=0,no=1).AUC(the area under the ROC curve)for predicting the risk of PE in LRCC patients after RLPN was 0.787(95％CI:0.724-0.816),with a Youden index of 1.460 2,sensitivity of 0.64,and specificity of 0.62.The Hosmer-Lemeshow goodness of fit test showed that the model had good calibration(x2=8.093,P=0.421 7).Conclusion Elderly LRCC patients are prone to PE after RLPN,which may be related to age,BMI index,surgery time,surgical approach,pneumoperitoneum pressure,postoperative bed rest time,TC and the use of intermittent inflation pressure devices.