摘要
目的:探讨儿童机器人辅助腹腔镜肾盂成形术(robot-assisted laparoscopic pyeloplasty,RALP)中缝针丢失的危险因素,并制定针对性的预防策略。方法:回顾性分析2019年1月—2020年1月在中国人民解放军总医院第七医学中心接受RALP的115例患儿资料。根据术中是否发生缝针丢失分为缝针丢失组(14例)和非缝针丢失组(101例),采用倾向性评分法(propensity score matching,PSM)匹配后,采用单因素logistic回归法筛选潜在危险因素,进一步采用多因素logistic回归法分析独立影响因素。结果:单因素分析结果显示,缝针丢失与以下因素显著相关:辅助套管直径为3mm、助手RALP经验不足(<10例)、未使用持针器传针、未塑形缝针至135°、腹腔内缝针数量≥2根、术侧为右侧、术中肠胀气(P<0.05)。多因素分析结果显示,助手RALP经验<10例(OR=5.62,95%CI:2.13~14.85)、未使用持针器传针(OR=5.23,95%CI:1.68~16.29)、未塑形缝针至135°(OR=4.21,95%CI:1.18~15.03)、腹腔内缝针数量≥2根(OR=5.25,95%CI:2.14~12.84)和术侧为右侧(OR=3.85,95%CI:1.45~10.23)是缝针丢失的独立危险因素(P<0.05)。结论:加强助手培训、规范用针操作流程、优化器械选择及关注解剖特点可有效降低RALP术中缝针丢失风险。
Objective:To identify key risk factors in suture needle loss during robot-assisted laparoscopic pyeloplasty(RALP)in pediatric patients,develop targeted preventive strategies,and provide evidence-based guidance for improving surgical safety.Methods:A retrospective analysis was performed on 115pediatric patients who underwent RALP at the Seventh Medical Center of Chinese People’s Liberation Army General Hospital from January 2019to January 2020.Patients were divided into the suture needle loss group(n=14)and non-loss group(n=101).After matching by propensity score matching(PSM),univariate logistic regression was used to screen potential risk factors,followed by multivariate logistic regression to determine independent influencing factors.Results:Univariate analysis showed significant associations between suture needle loss and the following factors:3mm auxiliary trocar,assistant experience<10cases,non-use of needle holder for needle retrieval,non-shaped suture needle,simultaneous use of≥2sutures in the abdominal cavity,right-sided lesions,and intraoperative intestinal distension(all P<0.05).Multivariate analysis identified insufficient assistant experience(OR=5.62,95%CI:2.13-14.85),non-standard use of needle holder(OR=5.23,95%CI:1.68-16.29),non-shaped suture needle(OR=4.21,95%CI:1.18-15.03),multi-needle manipulation in the abdominal cavity(OR=5.25,95%CI:2.14-12.84),and right-sided surgical approach(OR=3.85,95%CI:1.45-10.23)as independent risk factors in suture needle loss(P<0.05).Conclusion:Strengthening assistant training,standardizing needle-handling procedures,optimizing instrument selection,and paying attention to anatomical characteristics can effectively reduce the risk of suture needle loss during RALP.
作者
赵扬
沈晓丽
张晓威
路宽
马立飞
陶天
周晓光
李品
陶元东
周辉霞
ZHAO Yang;SHEN Xiaoli;ZHANG Xiaowei;LU Kuan;MA Lifei;TAO Tian;ZHOU Xiaoguang;LI Pin;TAO Yuandong;ZHOU Huixia(Senior Department of Pediatrics,Chinese PLA General Hospital,Beijing,100700,China)
出处
《临床泌尿外科杂志》
2025年第11期962-965,共4页
Journal of Clinical Urology
基金
解放军总医院第七医学中心儿科医学部创新人才培育科学基金项目(No:QZX-04-EKLHJH-1)。
