Clavien-Dindo 分级系统用于评估全咽-喉切除术和游离空肠移植术后的并发症。
Clavien-Dindo classification for grading complications after total pharyngolaryngectomy and free jejunum transfer.
机构信息
Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan.
Department of Plastic and Reconstructive Surgery, Nippon Medical School Hospital, Tokyo, Japan.
出版信息
PLoS One. 2019 Sep 12;14(9):e0222570. doi: 10.1371/journal.pone.0222570. eCollection 2019.
BACKGROUND
The frequency of postoperative complications is used as an indicator of surgical quality; however, comparison of outcomes is hampered by a lack of agreement on the definition of complications and their severity. A standard grading system for surgical complications is necessary to improve the quality of clinical research and reporting in head and neck reconstruction.
METHODS
The aim of this study was to compare postoperative morbidity after microvascular head and neck reconstruction between patients with versus without a history of prior radiation therapy (RT) by using the Clavien-Dindo classification. A group of 274 patients was divided into two cohorts based on the history of prior RT: the RT group included 79 patients and the non-RT group included 195 patients. Postoperative (30-day) complications were compared between the groups with a nonstandardized evaluation system and the Clavien-Dindo classification.
RESULTS
The grades of complications according to the Clavien-Dindo classification were significantly higher in the RT group than in the non-RT group. The frequency of postoperative complications did not differ significantly between the groups according to the nonstandardized evaluation system.
CONCLUSIONS
The Clavien-Dindo classification could serve as a useful, highly objective tool for grading operative morbidity after microvascular head and neck reconstruction when comparing similar defects and methods of reconstruction. Widespread use of the Clavien-Dindo classification system would allow adequate comparisons of surgical outcomes among different surgeons, centers, and therapies.
背景
术后并发症的频率被用作手术质量的指标；然而，由于缺乏对并发症及其严重程度的定义的共识，因此比较结果受到阻碍。有必要制定一种用于外科并发症的标准分级系统，以提高头颈部重建临床研究和报告的质量。
方法
本研究旨在使用 Clavien-Dindo 分类来比较有和无既往放疗史（RT）的患者接受微血管头颈部重建后的术后发病率。根据既往 RT 史，将 274 例患者分为两组：RT 组 79 例，非 RT 组 195 例。通过非标准化评估系统和 Clavien-Dindo 分类比较两组之间的术后（30 天）并发症。
结果
根据 Clavien-Dindo 分类，RT 组的并发症分级明显高于非 RT 组。根据非标准化评估系统，两组之间的术后并发症发生率无显著差异。
结论
当比较相似的缺陷和重建方法时，Clavien-Dindo 分类可作为一种有用的、高度客观的工具，用于评估微血管头颈部重建后的手术发病率。广泛使用 Clavien-Dindo 分类系统将允许不同外科医生、中心和治疗方法之间进行充分的手术结果比较。
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