Retrospective Analysis Of Problems Related To Simple Nephrectomy Of Single-center In The Past Three Years

Objective:Retrospective analysis of cases of simple nephrectomy due to benign disease of Department of Urology of The First Affiliated Hospital of Kunming Medical University in the past three years.In order to provide guidance for clinical work,we identify the most common pathological types that lead to nephrectomy and analyze the risk factors of complications.Methods:A total of 272 simple nephrectomy cases were collected from the First Department of Urology,the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2019.According to the patient's disease type,it is divided into four groups:stone-related diseases,tuberculosis,other benign lesions leading to non-functioning kidneys,and other reasons leading to nephrectomy.Recording the operation method(laparoscopic surgery or open surgery),operation time,blood loss,blood transfusion rate,conversion rate and intraoperative and postoperative complications.Postoperative complications were classified according to Clavien-Dindo classification,Clavien?2 can be considered as clinically significant postoperative complication.Analyzing the differences in complications of simple nephrectomy between different groups;Analyzing predictive factors of calculi-related nephrectomy complications combined with patient case data;Exploring the methods for evaluating the difficulty of simple nephrectomy combined with relevant literature.Results:Statistics of nephrectomy in the past 3 years,simple nephrectomy accounted for 75.5%(272/360).Of the 272 cases of simple nephrectomy,244 cases were laparoscopic surgery and 28 cases were open surgery.Stone-related nephrectomy accounted for 153 cases(56.2%),45 cases of tuberculosis,57 cases of non-functioning kidneys caused by other benign lesions,and 17 cases of nephrectomy caused by other reasons.In 19 patients(7.0%),the bleeding volume was?500 mL,54 cases(19.9%)with operation duration>3h,intraoperative complications were 9.2%,blood transfusion rate was 7.7%,open surgery rate was 4.8%,and postoperative clinically significant complication rate was 26.8%.Among the simple nephrectomy with different etiology,calculus-related cases not only accounted for the highest proportion,but also significant in the incidence of complications and conversion rate(7.2%).Patients with prior surgery(P=0.016),preoperative urinary tract infection(P=0.004)and low albumin(P=0.001)were associated with Clavien-Dindo score?2.Conclusions:The nephrectomy in our center in the past three years has been dominated by simple nephrectomy,and most of them are laparoscopic surgery.Among them,stone-related cases account for the highest proportion,and the incidence of complications and laparoscopic conversion rate are significant.Open surgery has a slight advantage in the length of operation.The advantages of laparoscopic surgery are less blood loss and short hospital stay after surgery.Patients with prior surgery,preoperative urinary tract infection and low albumin are possible risk predictors of complications for stone-related simple nephrectomy.There are abnormal anatomical factors such as peri-renal adhesions and fibrosis in the affected side of the kidney in stone-related cases.If the adhesions involve the renal hilum or the tissues outside the Gerota fascia,the difficulty of surgery will increase significantly.