结直肠手术中的医源性泌尿损伤：全国性队列的结局与风险因素

Iatrogenic urinary injuries in colorectal surgery: outcomes and risk factors from a nationwide cohort

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Techniques in Coloproctology

影响因子:2.9

分区:医学3区 / 胃肠肝病学3区外科3区

发表日期:2024 Oct 03

作者: P H McClelland, T Liu, R P Johnson, C Glenn, G Ozuner

DOI: 10.1007/s10151-024-03008-z

摘要

医源性泌尿损伤（IUI）在结直肠手术后可能引发严重并发症，特别是在诊断延迟的情况下。本研究分析与IUI及其延迟发生相关的风险因素。利用美国外科学会国家外科质量改进项目（NSQIP®）数据库，识别2012年至2021年期间接受结直肠手术的成人患者。采用多变量回归分析确定相关的风险因素和结局。共包括566,036名患者，其中5836例（1.0%）发生IUI，其中236例（4.0%）为延迟IUI。多种术前风险因素被识别，包括弥漫性癌症（调整比值比[aOR] 1.4，95%置信区间[CI] 1.2-1.5；p < 0.001）和憩室病（aOR 1.1，95% CI 1.0-1.2；p=0.009），以及高体质量指数（aOR 1.6，95% CI 1.2-2.1；p=0.003）和腹水（aOR 5.6，95% CI 2.1-15.4；p=0.001）与延迟IUI相关。腹腔镜手术方式与IUI发生风险降低（aOR 0.4，95% CI 0.4-0.5；p < 0.001），而与延迟IUI风险增加（aOR 1.8，95% CI 1.4-2.5；p < 0.001）。IUI和延迟IUI均与显著的术后并发症相关，后者尤以多器官严重并发症为表现。虽然结直肠手术中的IUI发生率较低，但未被识别的损伤可能会影响修复并引发其他不良后果。复杂的腹腔内疾病患者和接受腹腔镜手术的超大体型患者，发生IUI及延迟IUI的风险更高。

Abstract

Iatrogenic urinary injury (IUI) can lead to significant complications after colorectal surgery, especially when diagnosis is delayed. This study analyzes risk factors associated with IUI and delayed IUI among patients undergoing colorectal procedures.Adults undergoing colorectal surgery between 2012 and 2021 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP®) database. Multivariable regression analysis was used to determine risk factors and outcomes associated with IUI and delayed IUI.Among 566,036 patients, 5836 patients (1.0%) had IUI after colorectal surgery, of whom 236 (4.0%) had delayed IUI. Multiple preoperative risk factors for IUI and delayed IUI were identified, with disseminated cancer [adjusted odds ratio (aOR) 1.4, 95% confidence interval (CI) 1.2-1.5; p < 0.001] and diverticular disease [aOR 1.1, 95% CI 1.0-1.2; p = 0.009] correlated with IUI and increased body mass index [aOR 1.6, 95% CI 1.2-2.1; p = 0.003] and ascites [aOR 5.6, 95% CI 2.1-15.4; p = 0.001] associated with delayed IUI. Laparoscopic approach was associated with decreased risk of IUI [aOR 0.4, 95% CI 0.4-0.5; p < 0.001] and increased risk of delayed IUI [aOR 1.8, 95% CI 1.4-2.5; p < 0.001]. Both IUI and delayed IUI were associated with significant postoperative morbidity, with severe multiorgan complications seen in delayed IUI.While IUI occurs infrequently in colorectal surgery, unrecognized injuries can complicate repair and cause other negative postoperative outcomes. Patients with complex intra-abdominal pathology are at increased risk of IUI, and patients with large body habitus undergoing laparoscopic procedures are at increased risk of delayed IUI.