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与无计划转换为开放的激进和部分切除术相关的风险因素
Benjamin A Fink1, Young Son2, Kimberly C Toumazos3
1Department of Urology, Jefferson Health, Stratford, USA.
Cureus
|July 2, 2025
概括
最少侵入性脏手术可能需要计划外的转换为开放性手术. 更高的瘤阶段,ASA分类和异常的实验室值预测这些转换和更糟糕的患者结果.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 手术瘤学手术瘤学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 最少侵入性手术 (MIS) 是癌的标准,提供更快的恢复.
- 无计划转换为开放性手术增加了并发症和再入院风险.
- 从MIS转换为开放性切除术的预测因素尚未得到充分理解.
研究的目的:
- 在切除术患者中确定非计划性转换为开放性手术的预测因素.
- 分析与计划外转换相关的结果.
- 在必要时改善患者选择进行开放性手术.
主要方法:
- 从2019-2020年ACS NSQIP数据库中对4,862名腎切除术患者的回顾性分析.
- 计划MIS (n=4,756) 和计划外转换为开放 (UCO) (n=106) 组之间的比较.
- 使用威尔科克森签名等级和费舍尔精确测试 (P<0.05) 的统计分析.
主要成果:
- 非计划的转换率为2.2%.
- 更高的瘤阶段 (T3/T4) 和美国麻醉学会 (ASA) 类3/4与无计划转换有关.
- 在UCO组中观察到的较差结果包括更长的手术时间,更多的输血和更长的住院时间.
结论:
- 意外转换的预测因素包括晚期瘤阶段,较高的ASA分类,功能受损和高的PT/INR.
- 意外转换与术后并发症增加和长时间住院治疗有关.
- 识别这些风险因素可以优化手术规划和为切除术选择患者.
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