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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (4): 692-698. doi: 10.19723/j.issn.1671-167X.2022.04.018

• 论著 • 上一篇    下一篇

基于多中心数据库的10年上尿路修复手术术式及术型变化趋势

左炜1,高菲1,袁昌巍1,熊盛炜1,李志华1,张雷1,杨昆霖1,李新飞1,刘靓2,魏来2,张鹏3,王冰4,谷亚明4,朱宏建2,赵峥1,*(),李学松1,*()   

  1. 1. 北京大学第一医院泌尿外科，北京大学泌尿外科研究所，国家泌尿、男性生殖系肿瘤研究中心，北京 100034
    2. 北京市健宫医院泌尿外科，北京 100054
    3. 应急总医院泌尿外科，北京 100028
    4. 北京市密云区医院(北京大学第一医院密云院区)，北京 101599
  • 收稿日期:2022-03-29 出版日期:2022-08-18 发布日期:2022-08-11
  • 通讯作者: 赵峥,李学松 E-mail:zz_185429@sina.com;pineneedle@sina.com

Trends in upper urinary tract reconstruction surgery over a decade based on a multi-center database

Wei ZUO1,Fei GAO1,Chang-wei YUAN1,Sheng-wei XIONG1,Zhi-hua LI1,Lei ZHANG1,Kun-lin YANG1,Xin-fei LI1,Liang LIU2,Lai WEI2,Peng ZHANG3,Bing WANG4,Ya-ming GU4,Hong-jian ZHU2,Zheng ZHAO1,*(),Xue-song LI1,*()   

  1. 1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
    2. Department of Urology, Beijing Jiangong Hospital, Beijing 100054, China
    3. Department of Urology, Emergency General Hospital, Beijing 100028, China
    4. Department of Urology, Miyun District Hospital (Miyun Hospital, Peking University First Hospital), Beijing 101599, China
  • Received:2022-03-29 Online:2022-08-18 Published:2022-08-11
  • Contact: Zheng ZHAO,Xue-song LI E-mail:zz_185429@sina.com;pineneedle@sina.com

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摘要：

目的: 探究近10年上尿路修复手术的病因以及上尿路修复手术术式、术型变化趋势。方法: 基于北京大学泌尿外科研究所牵头创建的多中心RECUTTER(Reconstruction of Urinary Tract：Technology，Epidemiology and Result)数据库资料，分析2010—2021年行上尿路修复手术患者的术前基本信息、围手术期临床资料及随访结果。比较2010—2017和2018—2021两年段间上尿路修复手术术式、术型、住院时间与手术时长、短期并发症发生率以及再次进行修复手术的患者比例。结果: RECUTTER数据库中共纳入1 072例患者，先天因素和医源性损伤是患者进行上尿路修复手术的主要病因，其中开放手术129例(12.0%)、腹腔镜手术403例(37.6%)、机器人手术322例(30.0%)、内镜手术218例(20.3%)，近10年手术量呈现逐年增高趋势，2018—2021年间机器人手术占比显著高于2010—2017年(P < 0.001)。1 072例上尿路修复手术患者的术型包括回肠代输尿管术124例(11.6%)、肾盂成形术440例(41.1%)、球囊扩张术229例(21.4%)、输尿管膀胱再植术109例(10.2%)、膀胱悬吊联合膀胱瓣手术49例(4.6%)、输尿管-输尿管吻合术60例(5.6%)、舌黏膜/阑尾补片修补术61例(5.7%)。肾盂成形术和球囊扩张术虽仍是主要术型，但补片修补术的占比显著增加(P < 0.05)。此外，2018年后手术时间明显增长(P < 0.05)，考虑与机器人辅助腹腔镜手术占比升高有关。多因素Logistic回归分析显示，微创手术(腔内治疗及机器人手术)是术后短期并发症的独立危险因素(P=0.050，OR=0.472)，可减少术后短期并发症的发生率。结论: 多中心RECUTTER数据库在临床科研工作中有重要的数据支持价值，为国内外更大范围多中心数据库建设提供了基础。近10年来，上尿路修复手术术式呈“微创化”、术型呈“复杂化”趋势，提示了机器人辅助手术在上尿路重建手术中的优越性。

关键词: 上尿路, 修复外科手术, 机器人手术, 数据库

Abstract:

Objective: To study the trend of surgical type, surgical procedure and etiological distribution of upper urinary tract repair in recent 10 years. Methods: The preoperative and perioperative variables and follow-up data of upper urinary tract reconstruction surgery in RECUTTER (Reconstruction of Urinary Tract: Technology, Epidemiology and Result) database from 2010 to 2021 were searched, collected and analyzed. The surgical type, surgical procedure, duration of hospitalization, time of operation, incidence of short-term complications, and proportion of the patients undergoing reoperations were compared between the two groups of 2010-2017 period and 2018-2021 period. Results: A total of 1 072 patients were included in the RECUTTER database. Congenital factors and iatrogenic injuries were the main causes of upper urinary tract repair. Among them, 129 (12.0%) patients had open operation, 403 (37.6%) patients had laparoscopic surgery, 322 (30.0%) patients had robot-assisted laparoscopic surgery and 218 (20.3%) patients had endourological procedure. In the last decade, the total number of surgeries showed a noticeable increasing annual trend and the proportion of robot-assisted laparoscopic surgery in 2018-2021 was significantly higher than that in 2010-2017 (P < 0.001). The 1 072 patients included 124 (11.6%) cases of ileal ureter replacements, 440 (41.1%) cases of pyeloplasty, 229 (21.4%) cases of balloon dilation, 109 (10.2%) cases of ureteral reimplantation, 49 (4.6%) cases of boari flap-Psoas hitch surgery, 60 (5.6%) cases of uretero-ureteral anastomosis, 61 (5.7%) cases of lingual mucosal onlay graft ureteroplasty or appendiceal onlay flap ureteroplasty. Pyeloplasty and balloon dilatation had been the main types of surgery, while the proportion of lingual mucosal onlay graft ureteroplasty plus appendiceal onlay flap ureteroplasty had increased significantly in recent years (P < 0.05). In addition, the time of operation was significantly increased (P < 0.05) after 2018, which was considered to be related to the sharp increase in the proportion of robot-assisted laparoscopic surgery. We found that minimally invasive surgery (endourological procedure and robot-assisted laparoscopic surgery) as an independent risk factor (P=0.050, OR=0.472) could reduce the incidence of short-term post-operative complications. Conclusion: We have justified the value of the RECUTTER database, created by the Institute of Urology, Peking University in data support for clinical research work, and provided valuable experience for the construction of other multi-center databases at home and abroad. In recent 10 years, we have observed that, in upper urinary tract reconstruction surgery, the surgery type tends to be minimally invasive and the surgery procedure tends to be complicated, suggesting the superiority of robot-assisted laparoscopic surgery.

Key words: Upper urinary tract, Reconstructive surgical procedures, Robotic surgical procedures, Database

中图分类号: 

  • R691.6

图1

RECUTTER数据库起始界面"

表1

上尿路修复手术患者的基线资料"

Items Year
2010 2011 2012 2013 2014 2015 2016
Number 11 18 10 17 42 59 27
Age/years, median (range) 26.0
(15-68)		 26.0
(14-71)		 36.0
(17-51)		 35.0
(15-60)		 28.0
(11-75)		 35.0
(15-63)		 34.0
(17-60)
Gender (male), n 8 10 6 9 20 35 15
Surgical side, n
Left 8 12 5 9 24 20 15
Right 1 4 5 5 17 29 7
Bilateral 2 2 0 3 1 10 5
Preoperative eGFR/(mL/min), median (range) 87.0
(65-103)		 81.0
(41-140)		 77.0
(51-168)		 85.4
(53-128)		 88.8
(59-129)		 92.5
(18-150)		 78.9
(42-98)
Operative time/min, median (range) 202.0
(112-344)		 157.5
(97-394)		 173.0
(67-363)		 162.0
(72-372)		 108.0
(49-276)		 114.0
(40-530)		 99.0
(49-332)
Hospital stay/d, median (range) 5.5
(3-14)		 5.5
(3-36)		 4.5
(1-7)		 4.0
(1-13)		 3.0
(1-32)		 4.0
(1-2)		 3.0
(1-33)
Surgical history of urinary tract repair, n(%) 0 6
(33.3)		 2
(20.0)		 3
(17.6)		 14
(33.3)		 12
(20.3)		 6
(22.2)
Overall success ratea 100.0%
(1/1)		 100.0%
(2/2)		 100.0%
(2/2)		 100.0%
(6/6)		 80.0%
(4/5)		 100.0%
(3/3)
Follow-up time/months, median (range) 8
(8-8)		 8
(7-9)		 17
(4-31)		 6
(2-86)		 13
(11-66)		 46
(12-64)
Complication, n(%) 1
(9.1)		 0 1
(10.0)		 3
(18.8)		 4
(9.5)		 4
(7.3)		 2
(7.4)
Items Year Overall P
2017 2018 2019 2020 2021
Number 79 148 215 195 251 1 072
Age/years, median (range) 32.0
(15-76)		 33.0
(8-77)		 34.0
(14-74)		 35.5
(13-80)		 34.0
(12-68)		 34.0
(8-80)		 0.990
Gender (male), n 32 71 103 103 129 541 0.564
Surgical side, n 0.040
Left 48 71 105 100 148 565
Right 24 61 92 70 82 397
Bilateral 7 16 18 25 21 110
Preoperative eGFR/(mL/min), median (range) 85.2
(43-119)		 79.7
(29-191)		 77.7
(45-129)		 83.4
(32-154)		 78.0
(25-203)		 81.0
(18-203)		 0.841
Operative time/min, median (range) 132.5
(42-487)		 147.0
(40-385)		 155.0
(40-450)		 153.0
(40-425)		 150.0
(40-560)		 148.0
(40-560)		 < 0.001
Hospital stay/d, median (range) 4.0
(0-93)		 5.0
(1-57)		 6.0
(1-68)		 6.0
(2-67)		 5.0
(1-64)		 5.0
(0-93)		 < 0.001
Surgical history of urinary tract repair, n(%) 30
(38.0)		 59
(39.9)		 75
(34.9)		 76
(39.0)		 86
(34.3)		 369
(34.4)		 0.045
Overall success ratea 100.0%
(14/14)		 100.0%
(26/26)		 91.5%
(43/43)		 99.3%
(136/137)		 98.6%
(139/141)		 97.9%
(376/384)		 0.029
Follow-up time/months, median (range) 42
(2-54)		 28
(3-42)		 18
(3-33)		 9
(2-38)		 6
(1-80)		 7
(1-86)		 < 0.001
Complication, n(%) 3
(4.1)		 5
(5.8)		 7
(7.6)		 6
(6.4)		 16
(7.7)		 52
(7.1)		 0.825

图2

2010—2021年行上尿路修复手术患者的病因分布"

图3

2010—2021年上尿路修复手术的手术量及术式变化"

图4

2010—2021年上尿路修复手术的术型变化"

图5

2010—2017年与2018—2021年行上尿路修复手术的术型比例"

图6

2010—2017年与2018—2021年间不同上尿路修复手术术型的住院时间"

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CN 11-4691/R
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