微创经皮肾镜取石术并发症的 Clavien-Dindo 分类系统的应用。
Application of Clavien-Dindo Classification System for Complications of Minimally Invasive Percutaneous Nephrolithotomy.
机构信息
Department of Urology Surgery, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, Zhejiang Province 315700, China.
出版信息
J Healthc Eng. 2021 Dec 15;2021:5361415. doi: 10.1155/2021/5361415. eCollection 2021.
OBJECTIVE
To investigate the clinical applications of the Clavien-Dindo classification system (CDCS) in the assessment of perioperative complications in minimally invasive percutaneous nephrolithotomy (MPCNL).
METHODS
Totally, 390 patients with renal stones in our hospital from March 2015 to March 2020 were included for this study and then were divided into observation group (complication group, 78 cases) and control group (noncomplication group, 312 cases) according to the incidence of perioperative complications in CDCS. Single factor analysis and multivariate logistic regression analysis were used to analyze the risk factors of the perioperative complications of MPCNL.
RESULTS
The total incidence of complication in the 390 cases with MPCNL was 20.00% (78 cases) according to CDCS, among which the incidence of complications at grades I, II, III, IV, and V was 6.92% (27 cases), 8.21% (32 cases), 2.82% (11 cases), 1.79% (7 cases), and 0.26% (1 case), respectively. The proportion of patients, that aged >60 years, complicated with comorbidities, sophisticated calculi, the preoperative albumin level (<35 g/L), the operation time (>180 minutes), intraoperative bleeding volume (>300 mL), and hospitalization time (>7 days) in the observation group was significantly higher than that in the control group ((75.64% vs. 61.86%, 38.46% vs. 24.36%, 83.33% vs. 69.55%, 83.33% vs. 69.55%, 70.51% vs. 30.76%, 53.85% vs. 36.54%, and 60.26% vs. 43.27%), all < 0.05). Multivariate logistic regression analysis showed that gender, associated comorbidities, preoperative albumin level, calculus complexity, operation time, and intraoperative bleeding volume (>300 mL) were correlated with the occurrence of complications ( ≤ 0.001, 0.001, 0.001, 0.001, 0.003, and 0.001 respectively).
CONCLUSION
The CDCS can give standard and more comparative criteria for the assessment of perioperative complications, which will provide reference data for reducing complications and ensuring safety profiles in these high-risk patients.
目的
探讨 Clavien-Dindo 分类系统（CDCS）在微创经皮肾镜取石术（MPCNL）围手术期并发症评估中的临床应用。
方法
选取我院 2015 年 3 月至 2020 年 3 月收治的肾结石患者 390 例，根据 CDCS 评估围手术期并发症的发生率分为观察组（并发症组，78 例）和对照组（非并发症组，312 例）。采用单因素分析和多因素 logistic 回归分析 MPCNL 围手术期并发症的危险因素。
结果
根据 CDCS，390 例 MPCNL 患者的总并发症发生率为 20.00%（78 例），其中并发症 I 级、II 级、III 级、IV 级和 V 级的发生率分别为 6.92%（27 例）、8.21%（32 例）、2.82%（11 例）、1.79%（7 例）和 0.26%（1 例）。观察组患者年龄>60 岁、合并症、复杂结石、术前白蛋白水平（<35 g/L）、手术时间（>180 分钟）、术中出血量（>300 mL）和住院时间（>7 天）的比例明显高于对照组（分别为 75.64%比 61.86%、38.46%比 24.36%、83.33%比 69.55%、83.33%比 69.55%、70.51%比 30.76%、53.85%比 36.54%和 60.26%比 43.27%，均<0.05）。多因素 logistic 回归分析显示，性别、合并症、术前白蛋白水平、结石复杂性、手术时间和术中出血量（>300 mL）与并发症的发生相关（均 P<0.001）。
结论
CDCS 可以为围手术期并发症的评估提供标准和更具可比性的标准，为减少高危患者并发症、保证安全性提供参考数据。
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