探讨达芬奇机器人辅助子宫内膜癌全面分期手术并发症的发生情况及危险因素。方法：回顾 性分析 2014 年 10 月 ~2019 年 6 月郑州大学第一附属医院收治的达芬奇机器人辅助子宫内膜癌全面分期手术患者的 临床资料，单因素分析采用χ 2 检验或 Wilcoxon 秩和检验法，将单因素分析中差异有统计学意义的变量纳入多因素 Logistic 回归分析。结果：279 例患者中，53 例（19.0%）发生并发症，其中术中并发症 5 例（1.8%），包括输尿管 损伤 2 例（0.7%）、血管损伤 3 例（1.1%），术后并发症 48 例（17.2%），包括深静脉血栓形成 17 例（6.1%）、 肺栓塞 5 例（1.8%）、肠梗阻 3 例（1.1%）、发热 8 例（2.9%）、淋巴潴留囊肿 7 例（2.5%）、盆腔脓肿 6 例（2.2%）、 乳糜漏 2 例（0.7%）。单因素分析结果显示达芬奇机器人辅助子宫内膜癌全面分期手术并发症的发生与患者年龄、 术中出血量、手术时间及合并糖尿病有关（P<0.05），多因素分析结果显示年龄 >60 岁（OR=3.083，95% CI： 1.545~6.154，P=0.001）、手术时间 >180min（OR=2.091，95% CI：1.053~4.153，P=0.035）以及术中出血量 >200ml （OR=3.617，95% CI：1.018~12.848，P=0.047）是达芬奇机器人辅助子宫内膜癌全面分期手术术中及术后总体并 发症发生的独立危险因素。多因素分析结果显示，年龄 >60 岁（OR=3.712，95% CI：1.359~10.137，P=0.011）、 肥 胖（OR=2.004，95% CI：1.027~3.908，P=0.041）、 术 中 出 血 量 >200ml（OR=7.033，95% CI：1.704~29.026， P=0.007）是发生 Clavien-Dindo Ⅱ级及以上术后并发症的独立危险因素。结论：达芬奇机器人子宫内膜癌术后并发 症 Clavien-Dindo 分级多为Ⅰ级和Ⅱ级，年龄 >60 岁、手术时间 >3h 及术中出血量 >200ml 是达芬奇机器人辅助子宫 内膜癌全面分期手术总体并发症发生的预测因素。年龄 >60 岁、肥胖、术中出血量 >200ml 是发生 Clavien-Dindo Ⅱ 级及以上术后并发症的预测因素。
To study the incidence and risk factors of perioperative complications in Da Vinci robotic-assisted comprehensive staging surgery on treating endometrial cancer. Methods: The clinical data of patients with endometrial cancer underwent Da Vinci robotic-assisted comprehensive staging surgery from October 2014 to June 2019 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Univariate analysis was performed with χ 2 test or the Wilcoxon rank sum test. The statistically significant variables were included in multivariate logistic regression analysis to identify risk factors of complications. Results: 279 cases in total were selected into this study, among which 53 cases (19.0%) found complications. 5 cases (1.8%) of intraoperative complications, 2 cases (0.7%) of ureteral injury and 3 cases (1.1%) of vascular injury were found in the 53 cases. 17 cases (6.1%) of deep vein thrombosis, 5 cases (1.8%) of pulmonary embolism, 3 cases (1.1%) of ileus, 8 cases (2.8%) of fever, 7 cases (2.5%) of lymphocele, 6 cases (2.2%) of pelvic abscess and 2 cases (0.7%) of chylous fistula were found in 48 cases (17.2%) of postoperative complications. Univariate analysis shows that age, intraoperative blood loss and operation time are related to the incidence of complications (P<0.05). Multivariate analysis shows that patients’ age >60 years (OR=3.083, 95% CI: 1.545-6.154, P=0.001), operative time >180 min (OR=2.091, 95% CI: 1.053-4.153, P=0.035) and intraoperative blood loss >200 ml (OR=3.617, 95% CI: 1.018-12.848, P=0.047) are risk factors to occurrence of complications. Multivariate analysis suggests that patients’ age >60 years (OR=3.712, 95% CI: 1.359-10.137, P=0.011), obesity (OR=2.004, 95% CI: 1.027-3.908, P=0.041) and intraoperative blood loss >200 ml (OR=7.033, 95% CI: 1.704-29.026, P=0.007) are risk factors to Clavien-Dindo grade II or higher grade of postoperative complications. Conclusion: Most postoperative complications were Clavien-Dindo grade I or II in robotic-assisted comprehensive staging surgery on treating endometrial cancer. Patients’ age > 60 years, operative time >180 min and intraoperative blood loss >200 ml are predictors of complications after robotic-assisted comprehensive staging surgery on treating endometrial cancer. Patients’ age >60 years, obesity and intraoperative blood loss > 200ml are predictors for Clavien-Dindo grade II or higher grade of postoperative complications.