摘要
目的 探讨根治性膀胱切除双侧输尿管皮肤造口术围手术期Clavien并发症分类，并分析其影响因素。
方法 分析117例行根治性膀胱切除双侧输尿管皮肤造口术患者的临床资料，采用Clavien并发症分级系统对患者围手术期并发症进行分级，运用Logistic回归分析患者围手术期并发症的可能危险因素。
结果 51例发生1种或1种以上的并发症，其中术中发生并发症3例。按Clavien分级分类，发生1～2级并发症30例，3～4级并发症21例，5级并发症0例。主要包括切口相关并发症19例，胃肠道并发症17例，肺部感染11例；围手术期总并发症发生率腹腔镜组低于开放组（28.57%比48.31%，χ2＝0.171，P＝0.680）；Clavien分级1～2级围手术期并发症发生率腹腔镜组明显低于开放组且差异有统计学意义（17.86%比39.33%，χ2＝4.363，P＝0.037）；Logistic回归分析结果显示术前低蛋白血症、术中输血情况及住院时间是患者围手术期发生并发症的危险因素（分别为χ2＝10.131，P＝0.003；χ2＝8.685，P＝0.012；χ2＝6.675，P＝0.018）。结论 根治性膀胱切除双侧输尿管皮肤造口术围手术期有较高的并发症发生率，低蛋白血症、住院时间较长及术中存在输血情况均可增加术后并发症的发生，Clavien分级系统是一种患者围手术期并发症分级管理及评价的有效方法。
Objective To explore the Clavien complications of patients given radical cystectomy and double cutaneous ureterostomy and to analyze the influencing factors.
Methods The clinical data of 117 cases undergoing radical cystectomy and double cutaneous ureterostomy from January 2002 to June 2015 were reviewed. The Clavien classification system was carried out to stratify perioperative complications. Logistic regression analysis was applied to define possible predictors of the perioperative complications.
Results Of the 117 subjects at least 1 perioperative complication developed in 51, including 3 cases of intraoperative complications. According to the Clavien system, 30 patients had grade 1-2, and 21 patients had grade 3-4 complications. The most frequent complication was incision-related complications, followeb by the gastrointestinal complications and lung infections. The total incidence of perioperative complications was lower in the laparoscope group than in the open surgery group （28.57% vs. 48.31%, χ2= 0.171, P=0.680）, and the incidence of perioperative complications of Clavien 1-2 was lower in the laparoscope group than in the open surgery group with the difference being statistically significant （17.86% vs. 39.33%, χ2=4.363, P=0.037）. Logistic regression analysis showed that hypoproteinemia, hospital stay and intranperative transfusion were the influencing factors of perioperative complications in patients undergoing radical cystectomy and double cutaneous ureterostomy （Respectively, χ2=10.131, P=0.003; χ2=8.685, P=0.012; χ2=6.675, P=0.018）.
Conclusion Radical cystectomy with double cutaneous ureterostomy is associated with a high perioperative comlications. Hypoproteinemia, longer hospital stay and intraoperative transfusion are independently associated with any complication in these patients. The Clavien system is a validated method that can be successfully used to stratify and evaluate perioperative complications during radical cystectomy and double cutaneous ureterostomy.
出处
《中华实验外科杂志》
CSCD
北大核心
2017年第4期688-690,共3页
Chinese Journal of Experimental Surgery
